Coronavirus and the climate crisis

Common causes and shared solutions

By Josh Karliner, International Director for Program and Strategy of Health Care Without Harm

We are living in a moment when two major global threats, a worldwide pandemic and the climate crisis, have suddenly converged.

In a matter of months COVID-19 has taken the world by storm, compelling countries to lock down; forcing the cancellation of events, travel, and gatherings of every stripe; shifting social norms; and pushing the world economy to the brink of recession. The current pandemic some scientists warn, and many of us fear, is a glimpse of a dystopian future with more of the same.

Climate change is a different beast. It is relatively slow moving, yet the crisis is now upon us as well, with communities the world over experiencing its myriad impacts: floods, drought, fire, disease. Without rapid major systems changes that alter our emissions trajectory over the next decade, the climate crisis, as the UN Secretary General has warned, poses an existential threat to human civilization as we know it.

Both are health emergencies, but of different kinds. With one, disease spreads like wildfire. And with the other, if you will, wildfires spread disease

Combined, these two threats serve up a serious set of challenges to families, communities, health systems, governments, and commerce everywhere. We are suddenly in one of those moments where the world, as perhaps we thought we knew it, peels back a layer to reveal something very different underneath. An altered playing field. A new set of rules. A transformed reality.

Photo by Clay Banks and NASA | Unsplash

While at first blush these two current crises are not necessarily related to one another, there are a series of climate change-coronavirus connections that are worth examining, as they reveal several common causes, synergistic impacts, and shared solutions.

With this essay I will try to explore this interplay between the coronavirus pandemic and the climate crisis. My aim is to contribute to a dialogue and discussion among those of us deeply concerned with climate change, planetary, and human health.

Four areas of interplay

As I began to sort through the multiple layers of this connection, in conversations with colleagues and in brief moments of thought as I scrambled to make sure my own family was safe, I began to organize the coronavirus-climate crisis convergence into four key areas:

  1. Common causes: How habitat destruction leads to both climate change and pandemics.
  2. Co-morbidity: How climate change deepens the impacts of pandemics like the coronavirus and vice versa.
  3. Health inequity: How our health systems are unprepared for climate change and the coronavirus, making the most vulnerable even more so.
  4. Systems change: Solutions for both climate justice and health equity: resilience, mitigation and leadership.

Let’s take each one of them in turn.

1. Common causes: Habitat destruction, climate change, and pandemics

The World Health Organization says land use change through deforestation is the leading driver of new disease emergence in humans. Specifically, deforestation for logging, agricultural expansion, and mining, a leading driver of climate change, is often a major driver of infectious disease outbreaks. While it often takes some retrospective investigation to understand the root causes of new pandemics, such as the coronavirus, land use changes, including deforestation and climate change, lie near the center of the causal cascade.

From 2000 to 2005, the loss of forests, primarily in tropical developing countries, accounted for approximately 12% of global greenhouse gas emissions. About 1.6 billion people (nearly 25% of the world’s population) rely on forests for their livelihoods, many of whom are the world’s poorest. Many are victims of highly unequal systems that have forced them to the forests’ edge. The remaining 5 billion-plus of us depend on forests for a variety of economic, social, and environmental benefits such as the rainfall, biodiversity, pollinators, carbon storage, and clean water they provide. However, each year approximately 12 million hectares of forest are destroyed.

Land use change through deforestation is the leading driver of new disease emergence in humans and a major contributor to climate change. Photo by David Clode | Unsplash

According to the United States Agency for International Development, “nearly 75% of all new, emerging, or re-emerging diseases affecting humans at the beginning of the 21st century are zoonotic.” This means they originate in animals. The diseases include AIDS, SARS, H5N1, Ebola, avian flu, the H1N1 flu, and now COVID-19. And while the current coronavirus outbreak originated in a wild animal market in China, more and more wild animals are coming into contact with humans, often because of deforestation.

For instance, both Sierra Leone and Guinea, where the Ebola virus raged last decade, experienced significant deforestation. Sierra Leone lost 96% of its forest by the 1920s and is at risk of losing the rest. Guinea, had lost 20% of its forests by 2014 when the Ebola outbreak began. As the Earth Institute at Columbia University notes, “the human activity that drives deforestation — logging, mining, slash-and-burn agriculture, demand for firewood, and road building — means more and more people are entering the forest, and thus forcing animals like bats to find new habitats closer to human civilization”

As a 2015 article in Annals of Global Health put it, “land-use change (eg, deforestation and other extractive industries) and agricultural intensification, both major contributors to greenhouse gas emissions, rank among the leading drivers of recently emerging infectious diseases in humans from wildlife…New or more frequent human contact with other species, resulting in some novel interactions, is facilitating pathogen spillover, leading to outbreaks.”

2. Co-morbidity: How synergies between climate change and pandemics can make things worse

While the climate crisis and pandemics like COVID-19 have some shared roots, the story does not end there. Both pandemics and climate change are known as threat multipliers. In this case this means that the two can feed off of one another in diverse ways, deepening one another’s impacts, expanding inequities, illnesses, and injustices around the world.

Fossil fuel-driven air pollution will, in all likelihood make millions of people around the world more vulnerable to COVID-19’s respiratory ravages. Climate-driven food scarcity not only weakens rural populations’ resistance to disease but also drives them to uninhabited areas to hunt for food, exposing them, and the world, to new viruses.

Air pollution makes millions more vulnerable to COVID-19

And a hotter climate will breed hardier viruses, making them more difficult for humans to combat. Meanwhile, climate refugees, fleeing drought, famine and/or flooding, are some of the most vulnerable populations where a virus like the coronavirus might prey.

Let’s take a look at these one by one:

a. Air pollution: There’s been a lot of talk about how air pollution, and carbon emissions have dropped radically as economic activity has severely slowed in places like China and Italy. However, this is only a temporary reprieve, a short-term blip. More important is that air pollution, primarily caused by the combustion of fossil fuels for transportation and energy generation — which is also the leading driver of climate change — is in all likelihood making COVID-19’s impacts worse. Here’s why:

People with compromised respiratory systems are at greater risk from COVID-19. One of the refrains all of us are hearing as the coronavirus spreads is if you are a smoker, you should quit to reduce your chances of getting really sick. That would be your choice, and a wise one at that. But what about the nine out of ten people in the world who are exposed to high levels of air pollution? What about the people in Delhi — all the people, young and old alike — who are smoking the equivalent of six cigarettes every day just by breathing? Or the people in the 20 other cities in India that are on the list of the 50 most polluted cities in the world? Or the people in California and Australia whose respiratory systems have been compromised by air pollution from climate-fueled forest fires?

https://aqicn.org/forecast/wuhan/

Or the people of Wuhan, who have suffered poor air quality for years (at the time of this writing, the air pollution index was over 160, rating as unhealthy) and who just last summer engaged in air pollution protests? They cannot kick the habit to protect their health when merely breathing is equivalent to smoking cigarettes.

So, is air pollution making the pandemic worse? We know that particulate matter from air pollution increases the risks of pneumonia, particularly for older people. We know the more air pollution you are exposed to, the sicker you are likely to get. We know that a 2003 study by researchers at UCLA’s School of Public Health found that during the SARS outbreak in China, patients with SARS were more than twice as likely to die from the disease if they came from areas of high pollution.

While we don’t yet know about this coronavirus, it stands to reason that COVID-19 will hit harder, and perhaps has already hit harder in air pollution-impacted communities. As the Indian physician network Doctors for Clean Air put it, “Exposure to air pollution in long-term reduces the capacity of organs to function fully and makes it more vulnerable to infections and diseases. In the context of the current COVID-19 pandemic, such individuals are likely to face severe complications.”

b. Food insecurity and malnutrition: It feels like biblical times when entire communities are consumed by fires, or floods, or disease, or for that matter, swarms of locust. The latter is what’s happening in the Horn of Africa right now, which is suffering the worst desert locust invasion in decades. The plague is devastating pastoralists and farming communities in Kenya, Ethiopia, Somalia, Djibouti, Eritrea, and Uganda. Its severity, which scientists are saying will increase in the coming months, is attributable to climate change-induced ocean warming, which is causing more intense tropical cyclones in East Africa, which in turn has created wet conditions conducive to the locust swarms. It is creating “an unprecedented threat to food security and livelihoods,” according the UN Food and Agriculture Organization.

There are at least two ways COVID-19 and other pandemics are connected with food insecurity

First, growing food scarcity from crop destruction wrought by locusts, droughts, or floods can lead to malnutrition, making entire populations more susceptible disease, including this coronavirus, which has just begun hit the African continent. Second, faced with potential famine, if they can, people will turn to the forest for bushmeat like bats, potentially putting them in contact with new viruses. This is not a theoretical situation. Almost 50% of all past Ebola outbreaks have been directly linked to bushmeat consumption and handling.

c. A warming climate and migratory viruses: Beyond agricultural disruption, extreme weather events can generate a multitude of impacts that influence disease. Heat and droughts lead to forest fires that drive wildlife closer to humans. Extreme weather can also disrupt relationships between predators and prey that keep pathogen-carrying pests like mice and mosquitoes in check. The range of some bat species in parts of central and western Africa could expand, leading to increased contact between bats and humans. Viruses are on the move more than ever in the era of climate change. As Jennifer Zhang, a Columbia University student, explains in a blog for the Earth Institute:

“Experts fear the climate crisis will accelerate…transmission by changing the boundaries and characteristics of existing animal habitats. Weather pattern changes and global warming are predicted to cause many wildlife species to migrate poleward (away from the equator) and toward higher altitudes, potentially putting animals in contact with new diseases to which they haven’t evolved resistance. In addition, as animals experience increased stress from these migratory changes, their immune systems may become weakened, thereby increasing both the risk of infection and amount of viral replication once infected. Decreased species diversity, an inevitable consequence of pollution and deforestation, has also been associated with more zoonotic infections within host animal populations. In summary, the climate crisis will lower host animals’ immune responses to zoonotic diseases, increase the rate of zoonotic infection by crippling biodiversity, and push animals into new migration routes that will bring them into greater contact with humans — all ultimately increasing the frequency and associated risks of infectious disease outbreaks.”

Animals like bats, that carry viruses are also migrating to new ecosystems in a warming world. Photo by James Wainscoat | Unsplash

As if all of this weren’t enough, as pathogens adapt to warmer temperatures in the natural world through natural selection, they can better survive the high temperature inside the human body. In other words, by adapting to climate change, they are also rendered more deadly as they become better adapted to the temperatures that our bodies deploy as a primary defense mechanism to fight off a virus.

d. Human migration, climate refugees, and pandemics: While viruses are on the move, so are millions of people. The Lancet Countdown on Health and Climate has found that climate change is already “the sole contributing factor for thousands of people deciding to migrate and is a powerful contributing factor for many more migration decisions worldwide.” Many of these migrants are living in squalor in refugee camps. There are 29 million refugees in the world today.

Refugees, as the Norwegian Refugee Council notes, “are especially vulnerable to coronavirus and other diseases, due to high geographical mobility, instability, living in overcrowded conditions, lack of sanitation, and lack of access to decent health care or vaccination programs.” Low- and middle-income countries with weaker health, water, and sanitation systems host 84% of the world’s refugees.

While as of this writing, there are no COVID-19 confirmed cases reported in refugee camps, they are a horrifyingly perfect breeding ground for a pandemic, striking fear in the heart of relief agencies. Many of these camps have little or no access to clean water. Parts of the Moira refugee camp in Greece, which houses Syrian refugees fleeing a war that was arguably fueled by climate change, has one water tap for every 1,300 people and no soap. Forget about handwashing. Doctors Without Borders is so concerned that a pandemic would rage out of control in this and other Greek camps, that they have called for their evacuation.

Echoing this concern is Erin Taylor of Save the Children who, commenting on the situation in Syria, where health systems have been decimated by war, notes that in Idlib province

“it would be incredibly difficult to control an outbreak among nearly a million newly displaced people in overcrowded conditions hemmed in by vicious fighting”

According to the Lancet, estimates of future climate migrants vary widely, but range from 25 million to 1 billion people by 2050. Many of these millions will be new refugees. They will be some of the most vulnerable to next pandemic to strike, and the one after that too.

3. Health inequity: How health systems are unprepared for climate change and coronavirus, making the most vulnerable even more so

One thing both the coronavirus and the climate crisis definitely have in common is that our health systems around the world are not prepared to handle either of these global threats. Investing in public health is crucial for both pandemic preparedness and for climate preparedness and resilience. Our hospitals, health centers, and public health systems need to be anchors of community resilience in times of emergency. Unfortunately, this is commonly not the case.

Often deeply under-resourced and weakened by neoliberal globalization that has defunded public health and privatized many services, our systems in country after country have been overwhelmed by the coronavirus, which itself has been strengthened — efficiently and rapidly spread around the world — by economic globalization. We have also seen many of these same systems paralyzed in recent years by extreme weather events — hurricanes, floods, wildfires, and more — triggered or made worse by climate change.

In essence, health care is unprepared to deal with the impacts of either of these major global threats to human health. Most everywhere you look, the inequities and inadequacy are glaring.

Health care is unprepared to deal with both pandemics and the climate crisis. Photo by Josh Karliner | Health Care Without Harm

As Wim De Ceukelaire and Chiara Bodini from the Belgian NGO Viva Salud write, “in many countries across the globe, public state-funded and government-run health systems have been gradually dismantled. Privatization has affected their ability to coordinate large-scale preventive campaigns, limited their capacity to expand curative services in crisis situations while eroding the broad public’s confidence in the health system as a whole”

In the United States for instance, which spends far more per capita and in terms of its total GDP on health care (18%), the system is embarrassingly unprepared. Why is this? A big reason is that while the system, based on private insurance, spends huge amounts of money on medical interventions of all types, public health has been gutted by a callous government bent on serving the corporate bottom line rather than public health.

Nationwide, as public health budgets have been cut, and then cut again, local and state health departments in the United States have lost nearly a quarter of their workforce since 2008. When crisis hits, they don’t have the resources they need. “Our public health infrastructure has been severely weakened over the years,” A. Scott Lockhard, director of the public health system in eastern Kentucky, told The New York Times when discussing COVID-19. “We have much fewer people to respond when we have a situation like this.”

Even as the coronavirus was surging across the world in February, the Trump administration released a proposed budget for fiscal year 2021 which, according to the American Public Health Association (APHA), included more than $693 million in proposed cuts to the Centers for Disease Control and Prevention (CDC). These cuts included $85 million from the agency’s Emerging and Zoonotic Infectious Diseases program and $25 million from the Office of Public Health Preparedness and Response. “In a time where our nation continues to face significant public health challenges — including 2019 novel coronavirus, climate change, gun violence, and costly chronic diseases such as heart disease and cancer — the administration should be investing more resources in better health, not cutting federal health budgets,” said APHA Executive Director Dr. Georges Benjamin.

Health departments in the U.S. have lost nearly a quarter of their workforce since 2008

Scandalous as the situation in one of the richest nations in the world may be, conditions in many parts of the planet are far worse, revealing even greater vulnerability for communities facing both COVID-19 and the impacts of the climate crisis.

As Bobby Peek, executive director of Health Care Without Harm’s South Africa partner groundWork, explains:

“As with the climate crisis, the coronavirus marks out the connections and disconnections of our profoundly unequal society. It arrived in South Africa with middle-class travelers, but it will not be confined to the richer classes. Around 60% of South Africans are poor, according to official statistics, and they carry a very high burden of disease starting with malnutrition, HIV and TB. People’s health is also compromised by high levels of pollution in the environmental sacrifice zones where our electricity is generated, our fuel is refined and minerals are mined and smelted. And while the richer minority have access to high quality health care, poor people do not. They rely on a public health system that is weakest where the need is greatest. Ironically, more government money goes into the private health system that serves the minority than into the public health system that has been subject to austerity budgeting for over two decades.”

According to the World Health Organization, at least half of the world’s population does not have full coverage of essential health services. And about 100 million people are still being pushed into extreme poverty because they have to pay for health care. All UN Member States have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals. But we are still a long way from it.

Two billion people rely on health care facilities without basic water services. Photo by Josh Karliner | Health Care Without Harm

This lack of access to essential health services is exemplified by the lack of access to basic Water, Sanitation and Hygiene, known as WASH, in thousands of health facilities around the world. For instance, 2 billion people must rely on health care facilities that lack basic water services, and 1.5 billion people must rely on facilities without sanitation facilities. Meanwhile, about half the world’s population is exposed to the negative health impacts of medical waste.

As with the case of the refugee camps cited earlier, if you can’t wash your hands, you lose one of the basic tools for controlling infectious disease, such as the coronavirus. In the context of responding to COVID-19, or in the context of a climate emergency, such as an extreme weather event, or to help control other serious health threats like anti-microbial resistance, basic WASH services are a fundamental public health pillar, absent in many places around the world.

Ramon San Pascual, Health Care Without Harm’s Southeast Asia executive director, explains, “WASH provides the fundamentals to primary health care facilities for countries like those in ASEAN region, where even basic sanitation, such as functional toilets, running water, waste treatment, and regular electricity, cannot be found in village-level health facilities/stations/centers. When WASH is not present at this level, patients seeking basic care will run to the city or provincial-level secondary crowding such hospitals, exacerbating inequity in health access, and triggering lack of resilience in the entire health care system.”

As we have seen with so many of the examples cited above, the most vulnerable are the most severely impacted by both climate change and COVID-19. Many already or may soon face the double whammy of being impacted by both. So, while both the current coronavirus and climate change impact everyone, it is those with the least resources who suffer the most. This is true whether it be an impoverished air pollution-impacted community with a high occurrence of respiratory disease being more vulnerable to the coronavirus; or a rural community having the crops it depends on to survive wiped out by an extreme weather event made all the worse by climate change, and then becoming more susceptible to both starvation and disease, including a pandemic like this one; or communities in countries both rich and poor not having access to adequate health services in times of emergency.

4. Systems change: Resilience, mitigation, and leadership as solutions for climate justice and health equity

Climate change and its main causes — the combustion of fossil fuels and deforestation, together with a global agribusiness industry based on both — will make pandemics and their impacts more frequent and more severe. Meanwhile, the coronavirus has made it clearer than ever that global human health and planetary health are intimately interconnected. If we don’t solve climate change, we are rigging the odds against ourselves when it comes to the number and severity of pandemics. If we don’t strengthen our health systems to respond to both, we are condemning people to die.

As Bobby Peek explains, however, penetrating the dark crisis of this pandemic are shafts of light: “The coronavirus has disrupted profoundly interconnected and fragile global systems. However, this gives us an opportunity to make our world more equitable and to test our just transition to a society with decent jobs for all, universal health care, and energy systems that benefit people and the biosphere. We have to change systems that place profit over health and well-being. We have to recognize and address the political, social and economic factors that govern how health or illnesses moves through our communities.”

Much needs to change to forestall both the worst impacts of climate change and a greater prevalence of pandemics in the future. Many of the solutions to address these two threats, and to achieve the twin visions of health equity and climate justice, are common ones. The framework Health Care Without Harm has developed to address climate change — organizing around the three interrelated pillars of resilience, mitigation, and leadership — is a useful way of exploring these shared solutions.

Resilience: The need for strengthening health system emergency preparedness and community resilience

We need to move from a world where banks and airlines get bailed out in a crisis while essential government health and environmental services that could help prevent or reduce a crisis’ impact continue to be eviscerated. Addressing this problem means reforming health systems that disregarded public health in favor of privatized health care, strengthening health systems in every country, and learning from examples of resilient health systems that have best withstood the current pandemic.

Photo by Susan Wilburn | Health Care Without Harm

Wim De Ceukelaire and Chiara Bodini from Viva Salud note how China mobilized its centralized political system and its prodigious human resources to roll out what might be the “most ambitious, agile and aggressive disease containment effort in history” to address COVID-19 led, in part, by an army of public health workers. They also point out that successful efforts in Singapore, Hong Kong, and Japan had a series of common elements:

“The three locations introduced appropriate containment measures and governance structures; took steps to support health-care delivery and financing; and developed and implemented plans and management structures. Integration of services in the health system and across other sectors has amplified the ability to absorb and adapt to shock. Besides, this experience has demonstrated that the trust of patients, health-care professionals, and society as a whole in government is of paramount importance for meeting health crises. Interestingly, also Singapore, Japan and Hong Kong rely on strong public health systems that enjoy wide support and that are able to reach and mobilize the population beyond health workers.”

They concluded: “What we can learn from the global coronavirus pandemic is that strong public health systems have the resilience to address massive health threats with the collective responses they require. Privatization of health services and individualization of risks might further undermine our ability to address this and future global pandemics”

Similarly, health system strengthening, which supports the elements that have made for resilience during this pandemic, will be necessary to build resilience as the climate crisis accelerates. These elements include disease surveillance, identification of vulnerable communities, health facility preparedness, cross-sectoral collaboration, and public trust.

Resilience built during this pandemic will also be necessary as the climate crisis accelerates

Investing in not only universal health coverage and WASH around the world, but also in reforming and building health systems as community and national leaders in confronting these crises and serving those impacted will be essential. Such an emphasis on health system strengthening and greater health equity dovetails with some of the basic principles of climate justice of respect for human rights and people’s right to development. Protecting public health from climate change is a climate justice issue, and climate justice is a health equity issue.

The “right to development” component of climate justice is a key phrase. It includes the right to health care. It also includes many more social determinants of health, such as access to adequate food for people to sustain themselves, clean drinking water, and safe and affordable housing. Meeting all of these basic rights would help build resilient communities that can better withstand the ravages of pandemic-induced disease and climate-induced disaster.

Within this context, as Health Care Without Harm Founder Gary Cohen suggests, “our public health and health care systems must respond in a way that redefines the meaning of community resilience. We have a responsibility to lead society on a path toward individual and community health built on local economies that create health and stability and prepare us for a world that will be increasingly challenged on both fronts. Health care is often the largest employer in our communities and also the largest purchaser of goods and services. Hospitals and clinics can be economic anchors in the storm, using their purchasing power to support community-owned businesses, local food producers, and more localized renewable energy sources. These are all core dimensions of community and planetary resilience, especially in situations where global supply chains are disrupted.”

Mitigation(*): Addressing root causes of pandemics and the climate crisis

For health facilities in many countries to become anchors in the storm however, requires systems change beyond hospital walls. For instance, governments must provide the correct incentives and capital to invest in resiliency strategies. Moreover, while it is essential to build health equity, foster resilience, prepare for emergencies, and adapt to a world where pandemics and climate change impacts are increasingly the norm, we cannot lose site of the need for big solutions to reverse these massive problems.

Disease prevention and climate mitigation can go hand in hand

If we are going to have healthy people living on a healthy planet, the world’s economic systems need be transformed to be based on principles of sustainable production and consumption. A new model must emerge from this crisis that protects people’s health, that protects the forests, that protects the climate and the air we breathe, the water we drink, the soil we cultivate. This model must strive to be equitable and just to meet all people’s basic needs.

It is in this context of striving for health equity and climate justice that we can look at some specific examples of how disease prevention and climate mitigation go hand in hand. Here are some examples:

Forest conservation and sustainable agriculture: It is urgent to protect and restore the world’s forests, both to forestall the accelerating climate crisis and to reduce the chances of future pandemics. The biodiversity of the world’s forests is an important source of genetic resources used for the development of many treatments, vaccines, and a range of biotechnology products used in both modern and traditional medicines. These include, for example, artemisinin as a treatment for malaria and digitalis for heart disease.

A just transition to sustainable agriculture is essential for halting deforestation. Photo by BBH Singapore |Unsplash

Protecting and restoring the world’s forests means transforming our economies and valuing habitat conservation and what is known as “ecosystem services.” It requires government intervention to protect forested lands. It encourages practicing sustainable forestry. And it means improving rural livelihoods and food security by making a just transition to sustainable agriculture; large tracts of land currently cultivated by corporate agribusiness need to be redistributed to small farmers living on the world’s agricultural frontiers, thereby providing them with a modicum of justice and reducing the incentive to slash and burn to clear forested land.

Professor Dr. K. Srinath Reddy, Public Health Foundation of India president, sums it up well: “Zoonotic viruses are now prancing around with greater frequency and gay abandon, because humans have set up conveyor belts for their easy travel — from wildlife to captive-bred veterinary populations and then on, to human habitat.”

Clean, renewable energy and transportation: With our knowledge that air pollution has deepened the morbidity and mortality from past coronaviruses like SARS, the COVID-19 pandemic provides yet another important argument for all countries to transition from a reliance on burning coal, oil, and gas for energy and transportation — a reliance that is driving climate and air pollution crises — and embrace solar, wind, and other renewables, along with clean transportation solutions. Air pollution kills. Clean energy can save lives.

As the Indian physician network Doctors for Clean Air put it, “The only way for India to fight COVID-19 or future pandemics would be if its environment is protected. This pandemic has made us realize the value for clean air, and this should be a key lesson going forward in building resilience in our country.”

Air pollution kills. Clean energy can save lives. Photo by Jason Blackeye | Unsplash

As governments prepare trillions of dollars in economic stimulus investments to respond to the severe economic fallout of this pandemic, there is an opportunity to save many lives in the future by investing in clean renewable energy. Some in positions of influence are advocating to seize this opportunity. For instance, Dr. Fatih Birol, executive director of the International Energy Agency, is arguing to “put clean energy at the heart of stimulus plans to counter the coronavirus crisis.” The health community around the world should get behind this call.

Climate-smart, pandemic-prepared health care: The economic stimulus packages many governments and international institutions are developing could also be targeted at investing in the health care sector itself, to help it better prepare for the next pandemic as well as to become climate-smart: both more resilient and less polluting. Health care’s contribution to climate change is significant, comprising more than 4.4% of net global emissions.

Overall, hospitals and health systems around the world can reduce their climate footprint by implementing energy efficiency, switching to renewable energy, investing in zero-emission transportation fleets, and more

These actions can help reduce overall greenhouse gas emissions and local air pollution, which can contribute to efforts to reduce the health impacts of pandemics over time. As discussed above, investing in WASH and other climate resilience initiatives, such as hospital infrastructure built and retrofitted to be safe and climate-smart, can also both support health care preparedness to respond to emergencies, while positioning health care facilities as community anchors in times of crisis.

Telemedicine is one area where the response to this pandemic can help accelerate a solution to health care’s contribution to the climate crisis. Telehealth has been deployed and expanded in China, Europe, and the United States in recent weeks in order to screen patients at a distance, rather than having them come into the hospital and possibly infect or be infected by others. As Poornima Prabhakaran, of the Public Health Foundation of India notes, “when numbers swell overnight…we will benefit from ‘task-shifting’ or enhancing telecare/telemedicine and mobile health care services while reserving our ICUs and ventilators for those that need it the most.”

The expansion of telemedicine as frontline means of delivering quality care, training staff, and conducting public health education can also be an important strategy for decarbonizing health care. It can reduce transportation emissions and offers the ability to make the health sector more resilient, smaller, less resource-intensive, and more cost-effective by reducing the number of patients in health care facilities.

In England, the National Health Service (NHS) is moving to maximize digitalized/virtual appointments in primary care in the midst of the pandemic — something Sonia Roschnik, of the NHS Sustainable Development Unit, notes might otherwise have taken months or even years. “So we are now seeing how we can accelerate key beneficial changes — digitalization, different ways of working, better protection of vulnerable people, resilience-building in communities and professionals, effective resource management — the things that we might not otherwise have been able to move so fast on. We are exploring accelerating appropriate changes at a time of crisis.”

The supply chain is another area where there can be significant synergy between pandemic preparedness and health care climate footprint reduction. Exploring, for instance, how, in the future, medical devices such as ventilators can be produced in a way that makes them as energy efficient as possible is important so they can be deployed more broadly across health facilities that have little or unreliable energy access, thereby providing access to care to a much larger cross-section of the population. The added benefit is that by making these and other medical devices super energy efficient would reduce the carbon intensity of medical devices overall, and therefore the supply chain.

Leadership: The voice of health

Health care professionals are on the front lines of the pandemic in every country. As Gary Cohen notes, they are “testing people, caring for people, and taking incredible personal risks at the same time. While health care professionals have always been among society’s most trusted spokespersons, the vacuum of national political leadership combined with a deluge of misinformation on the coronavirus make that trusted messenger role more important than ever.”

The coronavirus has brought to the fore the crucial role health care leadership can and must play in moments of global crisis

The credibility that so many health care professionals and public health leaders have gained or reinforced through this crisis as selfless, committed, and scientifically grounded is the same credibility that makes them such important potential climate leaders.

However, while governments around the world have declared “climate emergencies,” the speed of impact is significantly different between the coronavirus and climate change, with the former moving around the world lightning fast and the other a slow-motion existential disaster that will take place over decades. Seen from that lens, health care climate leadership must necessarily be different, building more slowly and steadily, while drawing on that same font of science, ethics, and public trust. This leadership has grown significantly in recent years. It needs to grow in leaps and bounds more in those to come.

Despite the inadequacies in the response to date, there is a hopeful aspect to this crisis,” notes Gary Cohen:

“In the matter of three months, health institutions in over 100 countries have mobilized to educate the public about a health threat that challenges all of humanity. Significant public and private funds have been mobilized to address this threat. Amazing cooperation and sharing of data is happening across the world. The news media is finally reporting on the crisis and facilitating awareness. The speed of this mobilization is exactly what is needed in the face of the climate crisis, which is not yet reached the level of pandemic that the coronavirus has, but will certainly do so in the future.”

This presents us with a fundamental paradox: Will meaningful response to the climate crisis only happen when it’s too late? Or can we learn from the coronavirus experience and take action in time?

Thirty years have passed since the world’s governments recognized climate change as a potential existential threat to civilization as we know it. Just as we have known that a pandemic like this would someday come (and that it will come again), we have also known that a global climate emergency is looming on the horizon, becoming closer by the minute.

The existential question then is: Can we recognize the coronavirus as a warning flare illuminating some of the contours of the coming climate emergency? Can we take this moment of global crisis to truly pause, reflect, and begin a transformation grounded in the fundamental values of the right to health and the right to a healthy environment? Can we overcome our collective inertia and take meaningful action to both reduce the risk of future pandemics and truly confront the climate crisis?

The future is in our hands.

(*) Mitigation in this context refers to addressing the cause of the problem as it is used by those working on climate change rather than how mitigation is currently being used as a term for a set of tactics to immediately confront the coronavirus. This essay does not pretend to comment on how the immediate life-threatening challenges of the coronavirus should be addressed, and with great respect leaves that to the medical and public health experts in the field.

Josh Karliner is International Director of Program and Strategy for Health Care Without Harm (HCWH). In this capacity he directs HCWH’s International Climate Program and leads strategic development in other areas. He has more than 30 years of experience leading organizations working on international environmental, health and social justice issues.

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.