Modifiable environmental factors account for almost a quarter of global deaths. Climate change and associated environmental issues such as air pollution severely impact on the health of communities around the globe, and today’s medical students have a unique choice between leading forward-thinking preventative action or managing the future health consequences of inaction. Given this stark choice, why aren’t globally minded medical students more interested in advocating for what the WHO director-general has called the ‘defining global health issue of our time’ ?
A cause that affects us all
The effects of environmental degradation on human health are wide and deleterious. Many of the most pressing global health issues of our time, ranging from food availability to water quality, malaria prevalence to cardiovascular and respiratory disease rates, are being increasingly exacerbated by the global effects of anthropogenic climate change, and dealing with this problem is a matter of urgency.
Individual organisations dealing with such problems receive funding, publicity and support from medical students and their organisations around the world. While these efforts are nevertheless worthwhile, greater consideration must be given to the climatic and environmental causes that intensify these issues.
Climate change is an existential threat to humanity, but its causes are the result of profound injustices mimicking global patterns of inequality such as health resource disparity and the burden of communicable disease; whilst wealthy nations account for the vast majority of global consumption and emissions, climatic consequences impact most heavily on impoverished populations least equipped to deal with such issues. Far from guiltless, Australia has the highest per capita material footprint of any country in the world on consumption-based measures of resource use. In comparison, though each of Bangladesh’s citizens consumes only half the resources of the global average, it will see a loss of 17 percent of its land mass by 2050 on current estimates of sea level rise, creating approximately 20 million climate refugees. Such stark inequity should evoke an immediate response from global health groups, especially in Australia, but currently seems to generate far less discussion than comparative global health issues.
In addition to such massive inequities, environmental issues exist that can be felt concretely throughout the developed world, albeit to a lesser extent. For example, one of the environmental issues most directly affecting human health is air pollution, an issue intrinsically linked with climate change in many ways. Greenhouse gases including carbon dioxide and air pollutants such as particulate matter, sulphur and nitrogen oxides, largely all stem from fossil fuel combustion. Particulates aggravate climatic effects by absorbing sunlight and altering precipitation patterns, and changes to the climate in turn prolong air circulation of pollutants through alteration of natural removal processes. The atmosphere over inhabited locations commonly contains tens of thousands of particles per millilitre, capable of penetrating deep into the lungs and inducing alveolar inflammation, which can exacerbate lung disease and lead to increased blood coagulability, cardiovascular disease and ischaemic stroke. Evidence also suggests such air pollution can impact on perinatal outcomes such as birth weight. Current guidelines rely, often unsuccessfully, on keeping pollution below ‘safe thresholds’, when evidence suggests there may in fact be no lower limit under which no health effects are observed.
Such devastating environmental issues require attention from populations around the world, and communities of medical students are well placed to lead immediate and necessary action on their health implications.
Historically, governments and other institutions above the level of the community have been heavily relied upon to take leadership on environmental issues. However, current systems for environmental protection are failing to meet the needs of the present and future global population.
Air pollution management is one such example. On the 30th October, 2018, the World Health Organisation will hold its first Global Conference on Air Pollution and Health, featuring a “call for urgent action” aimed at encouraging policymakers to produce more progressive solutions to a growing crisis of air quality. While undoubtedly a worthy effort, this action comes too late for the estimated 103.1 million disability-adjusted life years accounted for by outdoor ambient air pollution in 2015 – a measure of years of healthy life lost. Within that figure is 4.2 million premature deaths and similar numbers of people likely died as a result of air pollution in 2016 and 2017.
History would have us believe that international collaborative efforts are doomed to a large extent to be reactive, rather than preventative, on environmental issues. While global cooperation has had moments of marked success, such as the 1989 Montreal protocol which was able to successfully phase out use of ozone depleting chlorofluorocarbons, international law pertaining to issues such as water use, chemicals, and the climate is often incomplete and ineffective. A contemporary example of this is the 2015 Paris Agreement. While this agreement marks a significant achievement in international environmental collaboration, its aims of “keeping a global temperature rise this century well below 2 degrees Celsius… and pursuing efforts to limit further to 1.5 degrees” appear to be ambitious yet completely unachievable based on current action.  Present voluntary national contributions imply warming will in fact reach 2.6-3.1 degrees Celsius this century, and commitments would have to be substantially strengthened for prevention of disastrous interference with the global climate.
While governments and international organisations may play an important role in environmental protection, these structures cannot be solely relied on to instigate prompt and effective change on this time-sensitive issue. Medical students and doctors must recognise this fact, and commit to educating themselves and creating action in absence of support from these institutions.
Community level organisation, and hope for a healthier future
Medical students and doctors occupy a unique space in the public eye, and must utilise this privilege to advocate for those who do not. Climate change, and all its ugly associated symptoms, is a health issue, a humanitarian issue and a moral issue. It is imperative that we, as members of the medical community, take a stand now and fight for the health of our communities and planet, or we risk vast and irreparable damage.
Action on such issues not only prevents climatic and environmental disaster, but has a range of co-benefits. For example, creating sustainable cities through urban management strategies reduces greenhouse gas emissions, but also provides health benefits to residents through improved cooling and reduced air pollution. Research even suggests that the co-benefits of many climate mitigation policies provide enough cost reduction for them to have a net economic benefit, as well as the obvious climate and health advantages.
Though truly lasting environmental sustainability may only be achievable through a systemic shift in the way we value natural resources and the environment, individuals and groups can create essential change that impacts on broader society.
Environmental advocacy groups, for example, have been historically effective in creating change on a range of issues. Massive community response was instrumental in preventing the development of the Jabiluka uranium mine in 1998, when up to 14000 young people, including tertiary students organised by the National Union of Students, joined with Aboriginal action groups to run one of the most successful environmental campaigns in Australia’s history. In 2017, the ongoing national campaign against the proposed Adani Carmichael coal mine, which would be the largest coal mine in Australia and was called a “public health disaster” by The Lancet saw two health professionals arrested for protesting out of concern for the health impacts of the mine.[20-22]
A variety of strategies exist for medical students to become active in this space. Medical students are perfectly capable of lobbying elected representatives, organising or participating in public forums that discuss the interaction between environmental and health issues, or joining action groups. Becoming educated on these topics and spreading information empowers individuals to agitate for larger change. Using existing student groups such as medical societies to hold corporations to account for the environmental consequences of their production through boycotts and promotion can be an incredibly effective way to make change at a local level, and ensuring that student groups themselves are aware of their own carbon and waste footprint is a method of creating awareness and encouraging personal investment in the environment. Getting involved in local environmental groups can be as simple as searching for the environmental issues most relevant in your area and sending someone an email or attending a community meeting. Even individual actions such as turning off the lights or opting for the bike can be empowering and contribute to the efforts of millions of others attempting to reduce their carbon footprint.
Medical student organisations should be actively seeking collaboration with other community groups that lead change in this area. For instance, collaboration with First Nations peoples is an essential and oft-neglected component of any successful environmental strategy, and it is imperative that well-meaning groups provide a platform for Indigenous voices and knowledge to be included in any discussion involving the natural environment. In Australia, Aboriginal and Torres Strait Islander peoples successfully and sustainably thrived in a diverse range of ecosystems for tens of thousands of years, and Western ignorance of the strategies that facilitated these populations is a tragedy whose effects are perennially experienced in today’s bushfires, soil degradation crises, and ecological extinctions. Medical students should take responsibility for building relationships with First Nations Peoples, for health and social reasons as much as environmental. Indigenous community leaders are often the most passionate advocates for environmental protection, and open discussion and collaboration provides unique opportunities for community driven change as well as opening channels for discussion of other complex Indigenous health issues.
Strong, inclusive, community action creates change, and climate change is a truly global issue providing an opportunity for the medical profession to collaborate with and inspire other groups with leadership and initiative. Environmental health groups already operate in Australia and worldwide, and they need the support and initiative that the next generation of doctors and medical students can provide. Students and doctors have a responsibility to fulfil the expectations of social conscience the community has of us. If we don’t take urgent action, we can’t expect that anyone else will.
The author would like to thank Georgia Behrens for her help in making important revisions to the first draft.
Image 1: public domain, accessed from https://pixnio.com/es/diverso/humo-tecnologia-toxico-contaminacion-del-aire-clima-fabrica
Image 2: Frontline Action on Coal. Medical doctors and health professionals arrested whilst highlighting devastating health risks of Adani’s mega coal mine [Internet]. 2017 [cited 20 May 2018]. Available from: https://www.frontlineaction.org/_doctors_risk_arrest_to_stopadani
Conflicts of interest
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