World Earth Day, 22 April 2021, Medicus Mundi Spain | The relationship between environment and health has been known since time immemorial. The latest warning has been the relentless emergence of Covid-19, which has hit us in the form of a pandemic on a massive scale and at a infection rate never seen before in the evolution of the planet and of human beings. By now we assume that infectious diseases are emerging at an ever-increasing speed, most of them caused by pathogens that jump from animals.

On World Earth Day and after four years of absence from the Paris Agreement, the United States is inaugurating a Climate Summit on April 22-23, and inviting world leaders to participate. It will be the starting pistol on the road to COP26 – which will be held in Glasgow on 1-12  November with a year’s delay due to Covid19– A lot of time lost for such an important issue as the climate crisis. That is why this conference is seen as a springboard for other commitments to be made throughout the year. Eyes are on major emitters, such as China, to take more radical steps to actually reduce emissions in this decade. Japan, Korea and Canada will also present emission reduction targets closer to zero emissions. This should be a great opportunity to raise awareness of the need to include health in these discussions.

Among the most likely hypotheses about the origin of this pandemic are its climatic, as well as zoonotic, origin. The change in land use towards relentless deforestation – fires and logging in 2020 was the third worst year for forests with a loss of 12.2 million hectares according to Global Forest Watch -, agriculture or intensive livestock farming. These factors lead to the loss of biodiversity, and bring people closer to greater interaction with wildlife. This latest coronavirus has shown us that animals can serve as an intermediate host in the transmission of pathogens to humans. The fact that ecosystems whose function is to buffer the cold/heat binomial and protect us from zoonosis, among other functions, are being destroyed is a cause for global alarm.

A recent report by the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) on biodiversity and pandemics concludes that “the recent exponential increase in consumption and trade, driven by demand in developed countries and emerging economies, as well as population pressure, has resulted in a number of emerging diseases originating mainly in biodiverse developing countries, driven by global consumption patterns”. It seems clear that climate change and the COVID-19 pandemic are rooted in the same practices that are harmful to people and the environment.

But the link between climate change and health has not yet penetrated the public and their governments as it should. Climate change influences the social and environmental determinants of health, namely clean air, clean water, sufficient food and safe housing. In fact, the climate crisis is having an impact on health in all areas of the planet, with an estimated increase of 250,000 direct deaths per year due to malnutrition, malaria, diarrhea, heat stress, or changes in the distribution of vector-borne infectious diseases. And: the very causes of the climate crisis directly lead to death and suffering. WHO estimates that 13 million people die each year from environmental problems, such as air, soil and water pollution). Health systems themselves contribute to this climate crisis, since their carbon footprint, one of the most relevant causes of climate change, is 4.4% of the total carbon footprint.

In medicusmundi we have been concerned for many years about the effects of climate change on health, its main impacts, and analyzing, in dialogue with partner organizations in the South, the systemic response capacity that we can provide in interventions. We are  aware that climate change is the greatest global challenge for the achievement of the 2030 Agenda and the Sustainable Development Goals, having also a very important impact on SDG 3, related to health. It is essential to take urgent and radical measures if we want to maintain a climate compatible with traditional lifestyles in the most vulnerable places in the world. In this sense, in addition to proposing mitigation measures, medicusmundi will deepen the management of climate scenarios to determine the specific impacts on each project, as well as strategies and measures for adaptation and increased resilience to climate change.

Likewise, in correspondence with the international commitments assumed, we ask the government to take into account the following considerations:

  1. That Spain generates a credible roadmap for its health system to be “green” and resilient to climate change on the near horizon, starting with a strategic framework on the bidirectional relationship between climate change and health, and establishing the steps to be taken in the health system to adapt to climate change. This strategy should include a budget forecast and a clear definition of the role that the different actors in the system should play, especially primary health care, which is the level of the system that is most in contact with the public, and which can therefore serve to inform and raise awareness of this situation, in addition to its healthcare work.
  2. Spain should play a relevant role at the international level to establish health as a priority in the analysis of climate change, and support the WHO in declaring climate change a global public health emergency.
  3. That global policies on climate change take special account of health, not only as a cause but also as a consequence.
  4. That space be given to civil society participation, and that mechanisms for participation in the development of policies and strategies be established.
  5. That training on the causes and consequences of climate change be promoted, mainly among health professionals, who should be the first groups to be trained on the causes and consequences of climate change on health. Likewise, the causes and consequences of climate change on health should be disseminated and made known to the entire population.

The improvement of global health depends on reversing climate change with a global commitment to coherent policies that do not encourage consumerism or pollution. The Congress of Deputies has approved the Law on Climate Change and Energy Transition (the Senate’s procedure remains), a law that should allow Spain to comply with its international commitments in the fight against climate change, among which is to achieve the so-called “climate neutrality” “before 2050″. To this end, the law establishes a series of intermediate goals and specific measures in relation to emissions, renewable energies, vetoes on the extraction of hydrocarbons and uranium, sustainable mobility, air quality and the protection of biodiversity. With this, Spain is aligned with the European Union (EU) and its climate change objectives.