Mind the climate health gap

10 years on from the groundbreaking Climate Change Act, we take this week to investigate what preventing climate chaos will look like across the UK economy. From digital tech to the health system, governance to finance, and how to talk about climate change, we explore where we are falling short — and how we can change the rules to build an economy fit for the future.

Health inequalities in the UK are already stark. Both the length of your life, and the amount of time you can expect to live in good health, depend on your socio-economic status. Men in Blackpool, the most deprived local authority in England, die 7.4 years earlier than men in Wokingham, the least deprived, and will have 16.5 years less of healthy life. And the effects of climate breakdown will likely exacerbate these inequalities. Considerable effort has gone into understanding the health gap, but action has lagged behind. The health system needs to change tack. And part of that must involve support for action to tackle climate change.

Health threat of the century

The Lancet have called climate change ​“the biggest global health threat of the 21st century”. We know that without action to mitigate climate change we’ll be seeing (even) hotter summers, more flooding and more extreme weather events in the UK — directly causing disease, pollution, illness, displacement and death — at the same time as climate change overseas impacts the basic conditions we need to live a healthy life, including access to food, water and energy, as global supplies at an affordable price dwindle.

The impacts of climate change are unlikely to be felt equally. Those on low incomes – who are already more likely to have worse health – will suffer first and most from weather extremes, food shortages and flood damages, causing further health problems. Flooding, for example, is a major health risk. People whose homes have been flooded will be exposed to injuries, infectious diseases, and mental health problems. Those with money will be less flood-prone areas, insure themselves against flooding and make their properties more flood resilient. Those without money will not have access to these things, making them more liable to illness, injury and disruption.

Leading by example

Given the health impacts of climate change, the health system has a very strong reason to lead by example by drastically cutting its carbon footprint.

The health system represents over 10% of our economy and around 10% of the workforce. 5% of all road traffic is related to health and social care activity. This can place high demands on the environment if not carefully managed. Latest estimates for the consumption carbon footprint (covering emissions from building energy use, travel to and from sites, as well as goods and services purchased) for the NHS, public health and social care system in England is 26.6 million tonnes of carbon dioxide, representing 39% of public sector emissions in England alone. The NHS is the largest public sector contributor to climate change in Europe.

The work of the NHS Sustainable Development Unit shows how the carbon footprint of the health system has been reduced over recent years, and how it can be reduced further by designing, running, commissioning and purchasing goods and services sustainably. As well as the direct result on the UK’s emissions, this could also work to shape local economies in a sustainable direction. In addition, the NHS – as the country’s most cherished institution – has the power to set social standards. If the NHS operates sustainably, it will put pressure on others to do the same.

Championing efforts

However, action from the health system mustn’t stop with its own emissions. Health professionals have an essential role to play in championing policies to mitigate climate change, including by garnering popular support for them. The health sector has the trust of the population and have played a pivotal role in developing a popular support for far reaching legislation in the past, from smoking bans to mandatory seatbelts. Now is the time to play a prominent role in fostering a national public debate about the health effects of climate change. The UK Health Alliance on Climate Change brings together range of health professionals to advocate for responses to climate change.

Ensuring action benefits disadvantaged groups

Climate change will hit those on lower incomes, with poorer health, the hardest. But so will certain measure to fight climate change.

Domestic energy, for example, is responsible for more than a quarter of our energy use. One response that some propose is to remove subsidies on household energy bills to decrease energy use. Yet high fuel prices and cold housing are a significant cause of poverty and excess winter deaths, so higher energy prices are likely to make this worse for the poorest.

There are, however, often responses to climate problems that also have positive health impacts for disadvantaged groups. Investment of public resources in a programme of insulating homes, starting with those on the lowest incomes, would have a positive impact on both health and emissions. It could also provide jobs, reducing the risks to health posed by unemployment, and, if coupled with a procurement policy that supported quality jobs, would maximise the health benefits of employment.

Directors of public health and their teams are particularly well placed to coordinate climate action that improves, rather than undermines, the health of the poorest. They can monitor drivers of, and health threats from, climate change in their area, champion policies that improve both health and sustainability and then support healthy, sustainable action by convening departments, organisations and groups, investing and pooling resources and using their research expertise to evaluate impact. We know that such practice, however, is currently very difficult in the context of austerity and cuts to public health budgets, forcing a narrow focus on the short term and the statutory. Ironic, given the government’s supposed commitment to ill health prevention.

A public health opportunity

As we scour our economy for the deeper carbon cuts we now need, the health system should be front and centre. This means the NHS and social care leading by example. Health professionals – from national leaders to front line staff – can play a key role in driving public debate, championing efforts and facilitating and supporting sustainability in decision making and action at all levels, while ensuring that action promotes, rather than undermines the health of the poorest.

Climate change is a daunting public health risk. But if tackling it runs side-by-side with reducing health disparities between rich and poor, climate change could also be a great public health opportunity.

Image: Wendy North (CC BY-NC-ND 2.0)