The role of public health in climate change and sustainability: is the UK public health community’s response adequate?

Abstract

Climate change is the greatest public health disaster facing us today. Sucharita Yarlagadda, Premila Webster and Elizabeth Haworth from the University of Oxford suggest that only with firm and decisive action now can we hope to avert or mitigate an impending public health catastrophe1 While there is a scientific consensus that the global climate is changing, with increasing climate variability and extremes, rising temperatures and sea levels and increased frequency of natural disasters which impact on human health,2,3,4 against a backdrop of persistent world economic pressures, the role of the specialty of public health in responding to environmental and climate change is not clear and needs to be defined. Many governments, including those of the UK have committed to tackling climate change through adaptation and mitigation and carbon abatement measures. The Climate Change Act 2008 sets a legally binding target for reducing UK greenhouse gas emissions by at least 34% by 2020 and by 80% by 2050, using the 1990 baseline.5 The NHS has shown leadership in this area through the Good Corporate Citizenship model,6 the NHS carbon reduction strategy7 and the NHS Sustainable Development Unit's route map for sustainable health.8 These aim to, at least, meet government targets and demonstrate early success with a 10% reduction of the 2007 NHS carbon footprint by 2015. Since April 2010, a new mandatory emissions trading scheme has come into force, requiring increased efforts by NHS organizations to meet government carbon targets.9 Alongside this is growing evidence of substantial financial and health benefits of low carbon business models in response to climate change and sustainability.6,10 As recommended by the Lancet and University College London a new Public Health movement is needed.4 The time to act is now. However, there still seems to be a huge gap between knowledge/ evidence and coordinated public health action. To clarify the public health role, a UK-wide internet based survey of public health departments (service public health, academic public health and the health protection units) was conducted in April 2010. It sought to allow an assessment of climate change as a public health problem, identify actions and innovations already taken, and to promote a coordinated public health response. The preliminary results were presented at the 2010 Faculty of Public Health Conference. The response rate of 32% overall was disappointing, despite a reminder. Over 90% of this considerable UK public health workforce who responded agreed that climate change is an important health problem requiring public health action. Many respondents highlighted the need for a stronger NHS mandate and prioritisation, such as through the NHS operational framework. Most believed that further training and development is essential for effective action, but the urgency is sidelined by current restriction of financial resources to deal with this problem. Although the public health workforce believes that action is needed and there is a public health strategy11 and encouraging response by primary care trusts12 neither an overarching plan nor effective coordination exists. What is good for the planet is also good for health and policies and structural drivers to mitigate and adapt to climate change would have a large positive effect on population health, for example the health co-benefits of walking or cycling to work that both reduce emissions and improve health and wellbeing.13 Emergency plans must be improved, kept up to date and include an effective service response to unpredictable weather patterns because of climate associated disasters and problems. These include floods and related water contamination incidents, droughts, heat waves, food shortages, as well as the problem of emerging diseases such as arthropod-borne infections and other environmentally linked diseases such as skin cancers and cataracts due to reduction/loss of the ozone layer. …