Elsevier

The Lancet

Volume 386, Issue 10006, 7–13 November 2015, Pages 1861-1914
The Lancet

The Lancet Commissions
Health and climate change: policy responses to protect public health

https://doi.org/10.1016/S0140-6736(15)60854-6Get rights and content

Section snippets

Executive summary

The 2015 Lancet Commission on Health and Climate Change has been formed to map out the impacts of climate change, and the necessary policy responses, in order to ensure the highest attainable standards of health for populations worldwide. This Commission is multidisciplinary and international in nature, with strong collaboration between academic centres in Europe and China.

The central finding from the Commission's work is that tackling climate change could be the greatest global health

The physical basis

The Intergovernmental Panel on Climate Change (IPCC) has described the physical basis for, the impacts of, and the response options to climate change.2 In brief, short-wave solar radiation passes through the Earth's atmosphere to warm its surface, which emits longer wavelength (infrared) radiation. Greenhouse gases (GHGs) in the atmosphere absorb this radiation and re-emit it, sharing it with other atmospheric elements, and with the Earth below. Without this effect, surface temperatures would

The health impacts of climate change

The resultant climate change poses a range of threats to human health and survival in multiple, interacting ways (figure 1). Impacts can be direct (eg, heatwaves and extreme weather events such as a storm, forest fire, flood, or drought) or indirectly mediated through the effects of climate change on ecosystems (eg, agricultural losses and changing patterns of disease), economies, and social structure (eg, migration and conflict). After only 0·85°C warming, many anticipated threats have already

Non-linearities, interactions, and unknown unknowns

The magnitude and nature of health impacts are hard to predict with precision; however, it is clear that they are pervasive and reflect effects on key determinants of health, including food availability. There are real risks that the effects will become non-linear as emissions and global temperatures increase. First, large-scale disruptions to the climate system are not included in climate modelling and impact assessments.18 As we proceed rapidly towards 4°C warming by the end of the century,

The health co-benefits of emissions reduction

Acting to reduce GHG emissions evidently protects human health from the direct and indirect impacts of climate change. However, it also benefits human health through mechanisms quite independent of those relating to modifying climate risk: so-called health co-benefits of mitigation.26

Reductions in emissions (eg, from burning fossil fuels) reduce air pollution and respiratory disease, whilst safer active transport cuts road traffic accidents and reduces rates of obesity, diabetes, coronary heart

This Commission

6 years ago, the first Lancet Commission called climate change “the biggest global health threat of the 21st century”.1 Since then, climate threats continue to become a reality, GHG emissions have risen beyond worst-case projections, and no international agreement on effective action has been reached. The uncertainty around thresholds, interactions and tipping points in climate change and its health impacts are serious enough to mandate an immediate, sustained, and globally meaningful response.

Section 1: climate change and exposure to health risks

No region is immune from the negative impacts of climate change, which will affect the natural world, economic activities, and human health and wellbeing in every part of the world.31 There are already observed impacts of climate change on health, directly through extreme weather and hazards and indirectly through changes in land use and nutrition. Lags in the response of the climate system to historical emissions means the world is committed to significant warming over coming decades.

All

Section 2: action for resilience and adaptation

Adaptation measures are already required to adapt to the effects of climate change being experienced today. As shown in section 1, these risks will increase as worsening climate change affects more people, especially in highly exposed geographical regions and for the most vulnerable members of society.

This section outlines possible and necessary actions to limit the negative impacts and burden on human health, including direct and indirect impacts within and beyond the formal health system.

Section 3: transition to a low-carbon energy infrastructure

It is technically feasible to transition to a low-carbon infrastructure with new technologies, the use of alternate materials, changing patterns of demand, and by creating additional sinks for GHGs. This requires challenging the deeply entrenched use of fossil fuels. Any significant deployment to meet demanding CO2 targets will require the reduction of costs of mitigation options, carbon pricing, improvement in the research and development process and the implementation of policies and

Main sources of GHG emissions

In 2010, annual global GHG emissions were estimated at 49 GtCO2e.201 The majority (about 70%) of all GHG emissions can be linked back to the burning of fossil fuel for the production of energy services, goods or energy extraction (figure 8).202 Global emissions from heat and electricity production and transport have tripled and doubled respectively since 1970, whereas the contribution from agriculture and land-use change has slightly reduced from 1990 levels.203

When upstream and electricity

The global energy system

We know that the global energy system is heavily dependent on the extraction, availability, movement, and consumption of fossil fuels, and this system shows vulnerabilities when stressed. For example, the 1972 Organization of the Petroleum Exporting Countries (OPEC) oil embargo (which resulted in a cut of global production by 6·5% over 2 months) or the first Persian Gulf War (which caused a doubling of global oil prices over 3–4 months) each caused major pressure on the access and security of

The health burden of the current energy system

Although linked to a historical transformation in health, a fossil-fuel-based energy system also imposes significant health burdens (figure 10). The direct burden occurs through emissions of particulates and solid wastes (coal, oil, gas, biomass), risk of flooding (hydroelectricity), accidents and injuries (all), and emission of radioactive materials (coal, nuclear). But as the main driver of anthropogenic climate change, an energy system based on fossil fuels will also have indirect effects

Pathways to (GHG emissions reduction) pathways

Over the last two centuries, the prevailing pattern of national development has involved dramatic increases in productive capacity, supporting transformations in nutrition and housing, underpinned by development of fossil-fired energy supply, conversion, and distribution systems. Three overlapping stages of development can be identified:

  • Stage 1: typically low technology, relatively inefficient and with little regard for damage due to pollution and other externalities.

  • Stage 2: locally clean. As

The total economic cost of fossil-fuel use

Past failures to reduce GHG emissions mean that remaining within the required carbon budget is becoming progressively challenging. We are increasingly committed to a certain level of climate disruption, requiring adaptation measures to reduce the impact this is likely to have. Given that the world is already committed to some degree of climate change, and given too that the combustion of fossil fuels also emits a variety of other pollutants, the total external costs of burning fossil fuels (ie,

Standards and engagement

Energy efficiency standards may take many forms. However, all act to push a market, product or process to higher levels of efficiency (or lower levels of emission intensity), through regulation. Such regulations help to overcome market failures such as split incentives, a prominent example of which is the landlord–tenant problem, when the interests of the landlord and tenants are misaligned. The problem arises because, whilst the installation of energy efficiency measures would benefit the

Section 5: delivering a healthy low-carbon future

Central to this Commission's work is the question of whether human societies can deliver a healthy, low-carbon future. Sections 1 and 2 have explained the scientific basis for concern, the potential health dimensions of impacts, and the adaptation responses required. Sections 3 and 4 have demonstrated the technological and economic feasibility of tackling the problem. Yet over the past decade, global emissions have still risen sharply. The evidence to date of humanity's ability to respond

Section 6: bringing the health voice to climate change

Our studies point to multiple ways in which the health agenda may help accelerate the response to climate change. First are the positive lessons for international cooperation. No-one would suggest that national action to protect health should depend on a global, all-encompassing treaty. Yet few would deny that WHO and numerous other fora of international cooperation are important in accelerating, coordinating, and deepening responses to health challenges—particularly, but not exclusively, those

First page preview

First page preview
Click to open first page preview

References (318)

  • SS Lim et al.

    A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

    Lancet

    (2012)
  • K Grace et al.

    Child malnutrition and climate in Sub-Saharan Africa: An analysis of recent trends in Kenya

    Appl Geogr

    (2012)
  • B Jongman et al.

    Global exposure to river and coastal flooding: Long term trends and changes

    Glob Environ Change

    (2012)
  • Summary for policymakers

  • U Cubasch et al.

    Introduction

  • British Petroleum. BP statistical review of world energy June 2014. London: BP,...
  • P Ciais et al.

    Carbon and Other Biogeochemical Cycles

  • Trends in atmospheric carbon dioxide

  • G Balla

    Digesting 400 ppm for global mean CO2 concentration

    Curr Sci

    (2013)
  • Summary for Policymakers

  • M McMillan et al.

    Increased ice losses from Antarctica detected by CryoSat-2

    Geophys Res Lett

    (2014)
  • K Riahi et al.

    RCP 8.5—A scenario of comparatively high greenhouse gas emissions

    Clim Change

    (2011)
  • PA Stott et al.

    Human contribution to the European heatwave of 2003

    Nature

    (2004)
  • S Rahmstorf et al.

    Increase of extreme events in a warming world

    Proc Natl Acad Sci USA

    (2011)
  • F Otto et al.

    Reconciling two approaches to attribution of the 2010 Russian heat wave

    Geophys Res Lett

    (2012)
  • T Peterson et al.

    Explaining extreme events of 2012 from a climate perspective

    Bull Am Meteor Soc

    (2013)
  • S Herring et al.

    Explaining extreme events of 2013 from a climate perspective

    Bull Am Meteor Soc

    (2014)
  • T Peterson et al.

    Explaining extreme events of 2011 from a climate perspective

    Bull Am Meteor Soc

    (2012)
  • P Pall et al.

    Anthropogenic greenhouse gas contribution to flood risk in England and Wales in autumn 2000

    Nature

    (2011)
  • Turn down the heat: why a 4°C warmer world must be avoided

  • N Silver

    The signal and the noise: the art and science of prediction

    (2012)
  • Scrutiny inquiry into the summery emergency 2007

    (2007)
  • J Rockström et al.

    Planetary boundaries: exploring the safe operating space for humanity

    Ecol Soc

    (2009)
  • TM Lenton et al.

    Tipping elements in the Earth's climate system

    Proc Natl Acad Sci USA

    (2008)
  • K Anderson et al.

    Beyond ‘dangerous’ climate change: emission scenarios for a new world. Philos Trans A Math Phys

    Eng Sci

    (1934)
  • Health in the Green Economy

    (2011)
  • G Watts

    The health benefits of tackling climate change: an Executive Summary for the Lancet Series

  • Access to modern energy services for health facilities in resource-constrained settings

    (2015)
  • BH Walker et al.

    A handful of heuristics and some propositions for understanding resilience in social-ecological systems

    Ecol Soc

    (2006)
  • KR Smith et al.

    Human health—impacts adaptation and co-benefits. Climate change 2014: impacts, adaptation, and vulnerability Working Group II contribution to the IPCC 5th Assessment Report

    (2014)
  • S Hales et al.

    Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s

    (2014)
  • WN Adger et al.

    Human security

  • CB Barrett

    Food security and sociopolitical stability

    (2013)
  • S Bradshaw et al.

    Women, girls and disasters: a review for DFID

    (2013)
  • SN Jonkman et al.

    An analysis of the causes and circumstances of flood disaster deaths

    Disasters

    (2005)
  • Gender, climate change and health

    (2014)
  • JA Patz et al.

    Impact of regional climate change on human health

    Nature

    (2005)
  • C Aström et al.

    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment

    BMJ Open

    (2013)
  • S Russo et al.

    Magnitude of extreme heat waves in present climate and their projection in a warming world

    J Geophys Res D Atmospheres

    (2014)
  • D Coumou et al.

    Historic and future increase in the global land area affected by monthly heat extremes

    Environ Res Lett

    (2013)
  • Cited by (1266)

    View all citing articles on Scopus

    Co-chairs

    View full text