Climate Change and Health

NOTE: At the time I drew these pictures a year ago, to accompany a Resolution presented to the Washington Academy of Family Physicians House of Delegates, the focus was on climate change and the family physician. The lessons apply to us all--and we are, or can be, healers, in the broadest sense.

Hopefully the pictures mostly speak for themselves. A few points of clarification and intent:

First, on the “less-busy” side: On a finite planet, any species must eventually reach equilibrium with its environment. In a traditional graph it’s difficult to appreciate that this holds true for humans. To capture our growth in the last 200 years from 1 billion to 7 billion, everything prior to 1800 looks pretty flat. Yet it’s anything but. As the log-log scale shows, we’ve had one series of exponential leaps after another, and every time the curve gets close to flattening, a new “advance” results in another order-of-magnitude population growth. The great hazard is that our last two (or more) leaps have likely been unsustainable. Oil provides both the energy, through mechanized harvesting, as well as literally the substance, through petro-fertilizers, of our food growing. And biotechnology, while it has delayed the crashes predicted by Paul Ehrlich’s 1968 “The Population Bomb”, has resulted in further dramatic growth while increasing our reliance on mono-crops, which could prove susceptible to massive failures of disease, drought, or heat. The larger question is, even if we could produce vastly more food, would this result in improved quality of life, or even less worldwide hunger? To date it hasn’t.

The bottom of the page shows atmospheric CO2 in the last several hundred thousand years. Though we don’t have one continuous, unbroken record dating back to Earth’s formation, we do have, from ice cores looking at different carbon and oxygen isotopes, excellent data. What this graph can’t show, because of scale, is a comparison to the last known major warming period post-dinosaur extinction (65M years ago). But we know a lot about this period, called the Paleocene-Eocene Thermal Maximum or PETM, which occurred 55M years ago. At that time, massive release of carbon dioxide led to a period of global warming. Geologists have often used the PETM as the best recent analogy to today’s warming and CO2 levels. It has been offered in the lay press as a reassuring comparison, because while certain ocean species suffered extinction rates of at least 50%, most land animals did well. However, as described in geologist Robert Hazen’s 2013 book “The Story of Earth”, recent ice-core evidence has shaken scientists by revealing that The PETM’s 5 degree Celsius warming occurred over a time period of 10,000 to 20,000 years, and the CO2 release was also slow. Today’s rise in CO2 levels is at least 10x as fast, and the projected temperature increase—currently we are on track for 5-6C by 2100, the non-binding Paris agreement doing nothing concrete to slow this—is thus occurring at a rate 100 to 200x as fast.

This brings us to the “busy” side and the heart of the matter starting with Wile E. Coyote in the upper left: we are stepping off a cliff. What that cliff represents is a huge number of positive feedback loops, processes we’re setting in motion that will likely continue even if all emissions stopped tomorrow. This in combination with our population growth makes our current history frighteningly akin, as journalist Elizabeth Kolbert argues in “The Sixth Extinction”, to the K-T boundary (dinosaurs) or one of Earth’s other 5 mass extinctions. I call your attention to three of those: in the far upper right, as the permafrost melts, it will release huge sinks of methane, which is 20 to 80 times more potent than CO2 at trapping heat. Near the bottom left, as the ocean acidifies, we’re facing the loss of the very phytoplankton that both absorb CO2 and provide half of our breathable oxygen. And back to the upper right: Severe weather, such as multi-year droughts that Syria and other places are already in the midst of, are causing or exacerbating civil unrest while simultaneously stripping the resultant climate refugees of land to which they might otherwise relocate.

Thus in the center of the page: We are, already, in a crisis of the health of the public. Here and abroad the entire public sector is being slashed and/or privatized even as the wealth of the very very richest increases. This phenomenon is well-described by Naomi Klein in “The Shock Doctrine” (one example being New Orleans during and since Hurricane Katrina), and in her latest book, “This Changes Everything” she makes the compelling case that climate change could push public infrastructure past its breaking point.

And finally, the lower right, the family doctor! Why the family doctor? Because no one is talking about this. Because we give voice to our most vulnerable patients and communities. Because we have an opportunity to build something better. It would be easy to say, “If the door to 2 degrees C closes next year, does it really matter what we do?” Yet we really do have a unique chance to both slow down emissions and, in the process, mitigate the effects of climate change by building a more just, equitable, and sustainable society.

For a moment, and it is likely a brief moment, there is more than enough wealth in the world to bring about enormous good. The challenge is that wealth is concentrated, as per the extreme lower right corner, in the hands of a very very few individuals. Over a decade ago a study found that the world’s 3 richest men controlled assets greater than the world poorest 48 countries. The statistics have only worsened since then. In America today top CEOs make more in a year than their employees could make in 350 years, or 7 generations each working 50 years. Nearly everyone in the world would benefit in the short- and long-term by investing some of this wealth in the strategies proven to increase world peace and stability, namely, improving the educational status, economic status, and reproductive rights of women and children. And even the super-rich would benefit from this approach in the long-term, because no ultimately no one wins, if we all lose a livable planet.

This, I believe, is what we must stand up for. If not us, who, if not now, when?