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In this episode, we speak to Dr Marina Romanello (UCL Institute for Global Health) and Professor Ilan Kelman (UCL Institute for Risk and Disaster Reduction), about climate change as a health disaster.
Nina Quach 00:00
Hi everyone, and welcome back to Disruptive Voices. My name is Nina Quach and today I'm joined by two fantastic guests, Professor Ilan Kelman and Dr Marina Romanello, to talk about the link between climate and health. Ilan is a Professor of Disasters and Eealth at the UCL Institute for Risk and Disaster Reduction and the UCL Institute for Global Health and Marina is a Research Fellow at the UCL Institute for Global Health. And she's also a member of the Lancet Countdown team. Hi both, and thank you very much for joining me today,
Ilan Kelman 00:35
Thanks for the opportunity.
Nina Quach 00:37
So to start, let's provide a bit of context. In your research, what does the intersection of climate and health look like?
Ilan Kelman 00:46
Well thanks so much, I mean for me. I try and connect two huge areas, health, and disasters which is a point behind my joint appointment with the two Institutes and it's so exciting being able to bring them together and look for bridges, look for themes so one of the big themes which connects health and disaster is absolutely climate change. Other ones include migration, diplomacy also different groups, whether it's people with disabilities or gender. And for me, the key is really integration; we need to break down the barriers, we need to stop the separation which climate change has created itself separating itself from so many other topics and bring them together with many, many disciplines. One example which integrates climate change is actually diplomacy, which I mentioned. So, I do a lot of work on disaster diplomacy and health diplomacy, which these days is like vaccine diplomacy/COVID-19 diplomacy and it does include climate diplomacy, really saying whether trying to deal with these processes - stop disasters deal with climate change improve health - whether that does or does not bring together people, countries or organisations. Geographically, I work especially on islands, and in the polar regions. So I currently have one funded project from a consortium called the Belmont Forum, which is examining local responses to health impacts of climate change, and our two locations are Alaska and the Caribbean to compare them. Another one, on which I work with Marina, is Lancet Coundown for Climate Change and Health, and I'm sure that she can provide plenty of detail regarding that.
Marina Romanello 02:23
Hi Nina, first of all thank you so much again for the opportunity to be here chatting with you. To answer your question, the Lancet countdown is an international research collaboration and nucleuates research from all around the world to try to explore the human dimension of climate change, and the health dimension of climate change in particular. The core of the research that I do is all about developing metrics, developing really hard, numerical or qualitative indicators of how climate change is affecting our health and how our responses determine the health profile of the world. And we develop these indicators to track the world, as it's moving from climate change as a threat to human health and how the actions against climate change can act as an opportunity to improve health worldwide. Our research is really interdisciplinary; it nucleuates researchers from all around the world, to look at the health impacts of climate change adaptation for health, and how our actions to mitigate climate change are helping to improve health and delivering those health co benefits of climate change mitigation and how the economic profile of the world is moving towards a healthier economy or not. Finally, we also explore the political and public engagement in acknowledging that climate change is at its very core, a public health problem. So it really nucleates experts that range from Earth scientists, meterologists, health scientists, economists, social scientists - really really interdisciplinary.
Nina Quach 03:44
Thanks Marina, it's actually a very interesting approach because climate change is often framed as an environmental issue. And typically when I speak to my parents sometimes the reaction is, 'why would I change my behaviour to save the planet?', but we're seeing this framing sort of change, more and more and in the 2020 Lancet Countdown report actually, I saw a statistic that really caught my attention, which is that between 2018 and 2019, the coverage of health and climate change in the media has increased by 96% worldwide, and actually, there is more coverage now about climate and health than about climate change itself, which is quite striking and quite encouraging. So could you talk about in your experience, whether it's in academic circles or the response that you get from the public, what does that shift of framing and shift in perception, bring to the table?
Marina Romanello 04:38
To us it's really one of the crucial things is that understanding as you very clearly pointed out that climate change is, in essence, a human problem. For many many years we've known about climate change, and we've known we had to do something about it since the 60s so this is not a new problem, and we still have not managed to mitigate climate change to the pace that we need to. Our emissions are still leading to accumulated CO2 concentrations in the atmosphere, and will lead us to a world that today we know we'll be in the current trajectory, around three degrees warmer than pre-industrial times. When we know that 1.5 is already pretty dangerous. So we're not really hitting that mark. Probably only one of the reasons why this delay has happened is because for a very long time we thought that climate change was a problem that affected wildlife, that affect the polar bears, that will affect us perhaps in 2100. But our evidence, and science has now shown us that climate change is actually affecting us today. It's affecting our health currently, it's affecting our children, and will determine the health profile of these and future generations. And the extent to which that is affected - the extent to which we let that define our health - really depends on our actions, both through mitigation and through adaptation. I know Ilan has done great work on shifting that understanding from environmental hazards to impacts. And that understanding and that realisation of climate change as a current problem that is impacting us today and our children and it's not a future hazard, it's really crucial to get people to act on it and to shift the perception of climate change at a global level.
Ilan Kelman 06:18
And Marina's approach is actually so powerful and may actually help to circumvent the challenges that you mentioned Nina regarding your parents. Maybe we should be communicating this is not about saving the planet, but exactly as Marina's saying, it's about us. It's about saving ourselves. So everything that we need to do to tackle climate change, helps ourselves in so many other ways. And if we just let climate change run away, then we are going to see absolutely appalling really devastating mortality from heat and humidity, as well as other possible impacts. So that whole concept that Marina just said - this is about us, this helps us, this makes a difference for us. Maybe we should be communicating much more. Let's deal with ourselves, let's deal with those around us, and we need to work to deal with climate change and to solve the problems, particularly the fundaments, in order to have healthier, safer, better lives, better quality of life, better jobs for ourselves and for future generations.
Nina Quach 07:20
There's definitely an increasing sense of urgency and threat to future generations. But if I can take a step back and pick up on the idea of disaster, the way I think that most people understand it, or the way that we use it normally, would be to refer to a very sudden, very catastrophic event; typically we would think of earthquakes and tsunamis etc. To what extent does this concept apply to climate change, which is a much slower and somewhat predictable process?
Ilan Kelman 07:54
Completely the same, actually. It is so intriguing that the public concept of disasters is contrary to what decades of disaster related research, policy, and practice have indicated. So disasters happen, not because of the earthquake and not because of the tsunami, not because of a flood, not because of weather. Disasters happen because we build infrastructure, which cannot withstand these natural forces, even though we know how to. And we've so many places where a tornado whips through - not much happens. Or when an earthquake shakes half a country, and not much happens. Conversely we then get earthquakes and tornadoes which kill hundreds or thousands of people, and therefore the disaster is happening. So it's our choices, not what the environment does - or too often we force people to live in vulnerable places, we force people to live in vulnerable ways we remove resources and options for them, which means that the disaster occurs. We avoid the phrase natural disaster because disasters are not natural. And this applies directly to climate change. Climate change, by definition, is a change in the climate, which sort of makes sense, or climate being weather statistics means a change in weather statistics. Weather is simply the environment, we could deal with weather if we wanted to, but some people cannot afford the jobs, the infrastructure, the clothes, the opportunities to deal with weather and so weather changes and yes disasters happen because we're not ready. Now the exception of it as I sort of alluded to earlier is heat and humidity, in that what climate change is doing to heat and humidity is pushing it into regimes where we cannot survive outdoors. So this is a lethality. This is a terrifying aspect, and this is awful, awful weather, created by climate change, leading to disaster. But you know, floods, storms, droughts, landslides - all these other weather related aspects - we could deal with them if we want to, climate change is affecting them substantively, but we can't deal with them anyway, so it's really hard to pin the disaster on climate change. These disasters are not natural, they come from us, not the environment.
Nina Quach 10:10
How do we attribute the effects on health and lives, to a single cause? Whether it's a very sudden disaster or whether it's climate change which is taking place over many many years. Marina, you mentioned earlier that you were using some metrics and measures. Could you expand on that?
Marina Romanello 10:29
I will echo what Ilan said, we have to know that the hazard came from the climate but the health outcome is a compound of that hazard plus our preparedness, our adaptation, how we're exposed to it, how vulnerable we are and how we managed to reduce those vulnerabilities, exposure such that the outcome does not lead to the tragedy and catastrophe of the health impacts. We have very, very good scientific, very sound studies, called Detection and Attribution studies, that tell us, to which extent an extreme weather event is attributable to climate change. It says, how unlikely it would have been that a heatwave, like the one that we've seen this year in USA and in Canada, would have happened if there hadn't been an influence of climate change, and we know that heatwave was practically impossible without a climate change scenario. That has been quite well studied, and we have the statistics to determine that. Today, the death toll could probably have been avoided, we would have probably had a much lower death toll had we had prepared those populations to cope with that extreme of heat, and had health systems adapted to extremes of heat with early warning systems with identification of vulnerable populations with a sound response system to protect health. Attributing those deaths due to climate change, we can attribute the event of climate change, and we can attribute the deaths that happened to that event, but it's very important to keep that in mind those tests, much of them would have been avoided, have we had a good adaptation preparedness and response system in place.
Nina Quach 12:05
So what can we do to better prepare for that event? And I'm thinking in particular of protecting the most vulnerable among us.
Marina Romanello 12:14
One of the key challenges we're seeing is that we are not really identifying those vulnerable populations. The WHO does these health surveys where they try to track to which extent countries are doing health vulnerability assessments for climate change. In these assessments countries are meant to identify vulnerable populations, identify which are the biggest risks that those populations would be exposed to, and help pin down who the groups at high risk are so that you can protect their health in the event of a weather event or an extreme event caused by climate change. What we're seeing is that those vulnerability assessments are being carried out by less than 50% of countries, by that and large, really, really underfunded so they're not being carried at the rate that they should be, they're not being developed frequently enough, or with enough coverage to be able to really identify those populations at risk. The same with national adaptation plans - countries are really, really underfunded and they're not prioritising national adaptation plans for health. So that is a crucial component of what public health can do to avoid the worst health outcomes of climate change, to be able to strengthen their adaptation response and the identification of vulnerable peoples.
Ilan Kelman 13:30
And that makes so much sense, it just really strong policy and practice ways forward. Really it comes down to who is most vulnerable, in what ways are they vulnerable, but particularly why are they vulnerable? A lot of this information we have, or it's easy to find, but just the systems - the political systems - are not supporting us to discover and analyse that material, in order to move forward with policy and action. One unfortunate aspect among many is that our health systems today cannot even deal with current issues irrespective of climate change. As soon as we start talking about the climate crisis and the climate emergency we're divorcing ourselves from what we're doing to the climate change. We're trying to sort of push it onto this wide global ephemeral aspect saying "well yes someone has to do something about the climate", as opposed to us in terms of it being a behaviour crisis, and an emergency of our values which lead to climate change. So this really strikes at the heart of vulnerability causing the problems, long standing, chronic continuing issues such as health systems, which are inadequate to deal with typical health needs and we see that in the UK all the time, unfortunately, then we get the added layers on top of that - changing weather that we're not ready to deal with, or a pandemic - and it's not surprising that we saw a near collapse if not some aspects of collapse within the health systems.
Nina Quach 15:01
This might be a bit controversial, but I was wondering if there are any positive effects of climate change on health, not to minimise the negative aspects of course but I just thought maybe it could put things into perspective?
Ilan Kelman 15:14
From the beginning and climate change being a major international issue, some people were talking about winners and losers. And this was partially pioneered by Michael Glantz. This is not saying we want human caused climate change, this is not justifying it. But in fact, in the definition of adaptation from the United Nations bodies responsible for dealing with climate change, the definition of adaptation is exploiting beneficial opportunities. So what you raise Nina is absolutely appropriate and absolutely apt. One example is despite the horror which heat related deaths are going to bring to us, it seems likely the cold related deaths will decrease. Also, people are different, some like warmer temperatures, some prefer colder temperatures. One strong advantage, what climate change has brought to us is a lot more awareness about some of the health issues, and a lot more appropriate measures to seek long term sustainability both social and environmental and their interactions, rather than saying "Oh whatever, things will happen. We're not going to worry about it." So, despite a lot of the rhetoric, despite a lot of hyperbole surrounding climate change and its impacts, to some degree, it has been advantageous in focusing on many of the issues Marina mentioned like health, but also thinking about wider environmental conceptualizations. Ironically, some of the worst hit places by climate change, such as in the Arctic, many of the peoples there reap the rewards because they say this will make it more accessible, this will bring tourism, this will permit resource extraction much more readily. Are those good? Well, obviously, not necessarily. But on the other hand, who are we sitting in a world city with our privileges, who are we to tell them that they're completely wrong, and they should be thinking 400 years down the line, not just 40. So it's hard and it's a balance and I think your question is why we should avoid foisting everything on climate change: "Oh this is good, this is bad, this is advantageous, this is problematic" - let's look more to ourselves, our behaviour, our values, our actions, our approaches and say, "What do we want for ourselves and those around us now and future generations?". And I would hope that it's healthier, safer lives and livelihoods, more fulfilling lives and livelihoods and ways to say that no matter what the environment does, no matter what we do to the environment, we can take advantages from it without destroying ourselves, or the ecologies.
Nina Quach 17:47
Marina, would you like to share your perspective?
Marina Romanello 17:49
Yes, look I think Ilan already highlighted the question that you're raising is hugely important. It's true that there will be some small wins from climate change. We see it for example, one of the key things that we're often faced with when we talk about climate change and its impact on food systems is a very, very huge concern, but there's a small benefit from climate change: a) in very cold countries, the warmer temperatures might help crop production, And there's the cold CO2 fertilising effects that means when you have more CO2 concentration in the atmosphere, then plants have absorb more bad CO2 and therefore, in their photosynthesis they produce more mass. So, it will have fertilising effect that increases crop productivity. And that's an argument that we're faced with all the time. The reason why we don't cling on that too much, is because we know - and there's very robust studies - that say that in the whole balance, even when you take into account the fertilising effect from CO2, even when you take into account warmer temperatures favouring crop activity in certain countries, the overall balance is pretty negative. Much more so when you include extremes of precipitation that damage these crops, other extreme events - so what we're seeing is that while there might be small wins, the overall balance is negative. But it's important to acknowledge that, it's important to understand that thing that climate change is a threat, does not exclude those small wins because they will be there, and we have to understand that they will exist, even if the overall balance is negative. So it's important not to put everything in black and white because it is - as any complex system or complex topic but probably just going back to the science and to the whole objective balance is what the data is showing us is the right approach I would say.
Nina Quach 19:32
Thanks for coming with me on this tangent, but I think we still agreed that we should try to limit climate change as much as possible.
Ilan Kelman 19:39
Yeah, an it's not a tangent because as Marina said people raise it all the time. Even where there are benefits that does not justify us rapidly and substantially changing the environment. So, irrespective of the balance it really is a fundamental ethos, we're one species and one planet that we want to do better.
Nina Quach 19:57
Of course, yeah. So, on the international stage, negotiations and coordination on the topic of keeping climate under control are notoriously difficult for many reasons, including who's to blame, who's to take action and responsibility, there is an advantage to letting others act first. But also, like we said, different people depending on geographical context, depending on their social and economic situations will have very very different outcomes in the next 20, 50, 100 years. What are your suggestions for navigating this complex issue?
Marina Romanello 20:34
What we find is that, with climate change, there's been a lot of discussions about, exactly what you've mentioned, responsibility, a ecological debt, carbon debt - and this talk about who should go faster, who should go first, and who should bear the burden, particularly because we still have very industrialised countries that have really enjoyed a highly carbonised development, with lots of benefits to health, including the benefits that the past 200 years of development have provided to our health at the expense of the environment, so that's undeniable. We're today at a situation in which climate change is pretty out of control. And we're in a very critical position - we really, really need to mitigate damage, even with our best adaptation, we still will see higher risks from climate change impacts on health, unless we rapidly mitigate. We're seeing that the highly industrialised, highly technological countries are probably doing that transition based on technology to kind of lower carbon economies to renewable energies, not as rapidly as they should have, but they're still going through that transition, whereas there are many other countries that are still developing and growing their economies based on carbon intensive resources. It's important to understand that if the whole world does not go down this path, if we don't allow for all of the countries that are still growing their economies, and still need to grow their economies for their health, for their well being, to do that in a carbon efficient way and in a low carbon economy, the bottom line is always the same: it has to be done in a fair way, in a way that everyone can reach the same end point together, and otherwise, we all fail.
Ilan Kelman 22:13
Yeah, I mean that's such a good encapsulation of all the issues, and it really shows the depth and breadth of the difficulties and opportunities we face. I'd sort of throw in that we've actually been at this for quite a while, with no real success. So when we talk about the potential meeting in the UK they call COP26 We're talking annual, actually often not always annual, meetings - so 26 means we've come a long way. Same with major scientific reports where over the next year they'll be releasing the sixth assessment, and the assessments are usually 5, 6, 7 years apart. So, this has been going on a long, long time. Maybe we need to think about approaches which are different, and actually question whether this should be done in such a top-down, major international manner because it clearly is not working. It's also very much a concern that a lot of the focus and attention then goes to climate change, being isolated from many of the other international negotiations, international coordination, justice and equity, and interaction issues. Even if we solved climate change today, and everything was fine tomorrow, we would still have plastics, which ironically come from fossil fuels, we would still have nanoparticles, we would still have mass species extinctions and devastating ecosystem destruction, as well as the underlying causes of all these issues which are basically over-exploitation of people resources, human slavery, arms trade oppression sexism, racism, discrimination, all of those continue. All of those are absolutely fundamental to the causes behind climate change, and all of them would continue, irrespective of climate change. So really it's recognising that theoretically, why is climate change different? Why is it separate at these international levels? From the reality, from what we've experienced, we're well over generation in terms of action or attempted action, well over two generations in terms of knowledge and still we're not there, should we be thinking about something different?
Nina Quach 24:28
So what's the role of science in all of this, and I suppose not just science but research in various fields, how do we all work together to contribute to this debate, and hopefully make progress finally.
Ilan Kelman 24:42
I mean, fundamentally science and research are about trying to get it as right as possible. Is there a fundamental truth? Well that's one of the great philosophical questions which I guess we're not going to resolve today or through climate change, but ultimately we do need evidence, we do need facts, we do need the philosophy, we do need to know what's going on and what people perceive, and what people are experiencing. Science provides that. It all has to be focused on serving society. So we have to take the knowledge, the evidence, the so called facts, the information, and apply that for constructive, appropriate, effective action, which also includes policy. So the role to me of the scientist and the role of science is to serve society. For climate change within these wider context, it's to try and do so much better than we've done so far.
Nina Quach 25:35
Marina, what would you say is our shared role?
Marina Romanello 25:38
I think science has come a very long way, we have a very very good evidence base. What I think is key now is integrating that very scientific, sometimes very technical and obscure data, in a way that can be understood and interpreted, and can be used by policymakers, and by the general public which is so hugely important because it's all of us. So, getting the science out there, in a way that can be consumed and inform decision making, to me is the biggest challenge, and that requires unsiloing climate change and health, and getting experts from multiple different areas to talk to each other, such that we can understand not only the health impacts of climate change, but also how that affects our livelihoods, how that affects our jobs, our economies, our education, our mental health, our wellbeing, our infrastructure, and the place that we live. So getting people to talk to each other, multidisciplinary research, which is sometimes spoken a lot about but seldom implemented in a very cohesive way, and getting the information in a way that can be used, and is useful to policymakers, I think is the biggest contribution that we can make, now that the core of the research and the evidence is available.
Ilan Kelman 26:49
What's countdown doing to change the world?
Marina Romanello 26:52
I think one of the interesting things that is currently happening - we're seeing that more and more governments are starting to produce indicators on climate change and health, and we're seeing observatories popping up all over the place. Observatories are built many times on Lancet Coundown indicators which is quite interesting in kind of setting that blueprint. And more than just saying, "well we've actually inspired this", because I think that's only partially true - apart from saying "well this has been our contribution", I think it does a lot, the extent to which countries are starting to try to monitor, objectively, something that they know is their own responsibility. So the fact that countries have started to measure vulnerability to heat, impacts of heat waves, and acknowledge the incredible mortality that we have currently from those extreme events, so somebody can act against the evidence, against the numbers and monitor progress. That to me is a pretty big win, just the intention. It has been a topic that has been greatly ignored or is not addressed properly in many, many countries. I'm talking about, I don't know, we're seeing it in Peru, we're seeing it in Argentina, and the fact that everyone is now at least aware of the fact that we have to start tracking climate change impacts on health, and our progress towards mitigating it, is pretty huge.
Ilan Kelman 28:07
So I think, Marina, that the inspiration is there but also, as you say, it's more than that. It's about facilitating the process and legitimising it. So yeah Lancet Countdown started with a fairly focused core group, was definitely global, and it's maintained that. But then the ripples go out, we get the spin offs at the national level, and through the connections on other continents. We then say "yeah you know what, we do need to think about smaller scales", we do need to say "well it's all fine for an international journal to publish it and for an international team to be producing it, but Australia's doing its own report", and it's perfectly fair to say "well what about Australia - how can health workers in Australia support this, and what does health mean to Australia"? So a lot of it, as you're saying, and you're right, it goes far beyond the indicators, it goes far beyond the report. It is inspiring, facilitating, legitimising, and saying "you know what, this can be done, it can have a positive, constructive impact on policy and practice". Plus we're generating much needed new knowledge.
Nina Quach 29:12
Can I ask, what's the breadth of expertise in the Countdown, and in authors, because a lot of what we've discussed today touches on ethics and philosophy, and what do we want from humanity beyond these problems that are really small on the evolutionary scale. What's the place of philosophy, for instance, in the discussion?
Marina Romanello 29:34
Well you have a little social scientists, and political scientists that do focus their work on studying human behaviour, human perceptions, and how you drive change by modifying, for example, the way we understand climate change. So, we have physicists, medics, social political scientists, economists, epidemiologists, climate modellers. We have, really, a bit of everything, and I think that's really the only way in which you can approach a problem like this. We need to understand that climate change is here, it's now, and it's a health problem.
Nina Quach 30:08
Hopefully, we manage to do that but in the meantime, thank you so much to both of you for joining me today. It has been really interesting.
Ilan Kelman 30:17
Thanks for the opportunity.
Marina Romanello 30:18
Thank you, Nina.
Nina Quach 30:23
This episode of Disruptive Voices was presented by myself, Nina Quach, and produced by the UCL Grand Challenges team. Our guests today were Dr Marina Romanello and Professor Ilan Kelman. The music is by David Szesztay. If you'd like to hear more on this topic, check out the first episode of the Public Health Disrupted podcast. For more episodes of Disruptive Voices, visit UCL Minds podcasts or follow us on Twitter @GrandChallenges.