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Relieved somewhat of the heavy burden of staff wages and expenditure on medicines, we have been able to use money provided by the church to develop infrastructure such as buildings, beds, and equipment so that our hospitals, while still very modest, are able to offer a good service. I read this Series together with the excellent Lancet Commission Report on Global Surgery and Anaesthesia.1 We have seen progress in many areas but the calamitous state of surgical and anaesthetic care has until now been largely overlooked. It is good that this may be changing and in view of these articles on faith-based health care it will be important to ensure that such facilities are taken into account as we seek solutions. Surgical and anaesthetic care is integral to many of these units, providing an essential source of safe and accessible care of reasonable quality for many people. I declare no competing interests.
David McAdam
[email protected] Chitokoloki Mission Hospital, Chitokoloki, Northwestern Province, Zambia 1
Meara JG, Leather JM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386: 569–624.
Climate change and health The report of the 2015 Lancet Commission on Health and Climate Change 1 is timely and welcome, particularly because of the emphasis on the health benefits of transition to sustainable ways of living. However, there is little in the report on the potential role of indigenous and local knowledge in both adaptation and mitigation responses for human health. This lack of attention is not confined to the health sector, and has been observed in other societal sectors that are the target of adaptation and mitigation efforts.2 430
Indigenous and local knowledge is the understanding, innovations, and practices of indigenous and local communities that have developed from experiences gained over the centuries and adapted to the local culture and environment.3 Many of the effects of climate change will be felt by communities in developing countries and indigenous communities on the margins of society. In these contexts, indigenous and local knowledge can certainly be used to provide benefits for human health. For example, in Pacific Island countries, agricultural practices based on indigenous and local knowledge, including crop diversification and food preservation, have been used as a strategy to ensure food security and enhance nutrition under climate change and variability.4 In north African countries, architectural designs based on indigenous and local knowledge have been used to adapt to heat stress and to conserve energy in urban settlements,5 and in Canadian Inuit communities, indigenous and local knowledge has been used to read changing weather and snow patterns, and thereby moderate climate-related health risks from hunting practices.6 There is a pressing need for further attention to the role of indigenous and local knowledge in climate change responses. We declare no competing interests.
*Natasha Kuruppu, Anthony Capon
[email protected] International Institute for Global Health, United Nations University, 56000 Cheras, Federal Territory of Kuala Lumpur, Malaysia 1
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Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861–914. Kuruppu N, Willie R. Barriers to reducing climate-enhanced disaster risks in small islands through anticipatory adaptation. Weather Clim Extremes 2015; 7: 72–83. Convention on Biological Diversity. What is traditional knowledge? https://www.cbd.int/ traditional/intro.shtml (accessed July 1, 2015). Fletcher SM, Thiessen J, Gero A, Rumsey M, Kuruppu N, Willetts J. Traditional coping strategies and disaster response: examples from the south Pacific region. J Environ Public Health 2013; 2013: 1–9.
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Kamal A. The morphology of traditional architecture of Jeddah: climatic design and environmental sustainability. GBER 2014; 9: 4–26. Ford J, Cunsolo Willox A, Chatwood S, et al. Adapting to the effects of climate change on Inuit health. Am J Public Health 2014; 104: E9–17.
The Lancet Commission on Health and Climate 1 strongly urged the health sector to tackle climate change, especially from a mitigation perspective, which is a step forward from the traditional focus on health sector adaptation. We laud the authors’ portrayal of climate change not just as the “biggest global health threat”,2 but also the “greatest global health opportunity”, terms that resound with both a sense of urgency and optimism, qualities that are the hallmark of global health. While we welcome this surge of optimism, we also bring to attention some features of the report that must be approached with caution. First, the summary lacks adequate emphasis on the critical role of developed countries in mitigation. Instead, the “2200 coal-fired plants currently proposed”, were emphasised, which may be interpreted as disproportionate blame on developing countries. Many of these coal projects receive funding from governments of developed countries.3 If we are to ensure that no additional coal plants are constructed in developed or developing countries, a solid call for coal divestment should have been recommended by the Commission. Norway’s recent divestment shows how actions in developed countries can paralyse the further spread of coal use in the developing world.4 Second, the report gives an impression of developed countries, with available technology for better energy access and mitigation of climate change, as suppliers of solutions to developing countries. The report even recognises that “the bulk of technology transfer occurs between developed countries… [and] this does nothing to overcome the low availability of mitigation technologies in developing www.thelancet.com Vol 387 January 30, 2016
Correspondence
We declare no competing interests.
*Adithya Pradyumna, Renzo Guinto
[email protected] Society for Community Health Awareness, Research and Action (SOCHARA), Koramangala 1st Block, Bangalore, Karnataka, India 560034 (AP); and Healthy Energy Initiative, Health Care Without Harm-Asia, Brgy. Central Diliman, Quezon City, Philippines 1100 (RG) 1
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Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861–914. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693–1733. Bast E, Godinot S, Kretzmann S, Schmidt J. Under the rug: how Governments and international institutions are hiding billions in support to the coal industry. USA: Natural Resources Defense Council, June 2015. http://priceofoil.org/content/uploads/2015/05/ Under_The_Rug_NRDC_OCI_WWF_Jun_2015. pdf (accessed July 29, 2015). Carrington, D. Norway confirms $900bn sovereign wealth fund’s major coal divestment. The Guardian, June 5, 2015. http://www. theguardian.com/environment/2015/jun/05/ norways-pension-fund-to-divest-8bn-fromcoal-a-new-analysis-shows (accessed July 29, 2015). Walpole SC, Rasanathan K, Campbell-Lendrum D. Natural and unnatural synergies: climate change policy and health equity. Bull World Health Organ 2009; 87: 799–801.
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The Lancet Commission on Climate Change1 calls on health professionals to mobilise and lead against climate change, as they have before against health threats such as tobacco and HIV/AIDs. However, shortfalls in current undergraduate curricula may mean tomorrow’s doctors are ill-equipped to lead in this area. We agree that health professionals are uniquely placed to communicate to the public the detrimental health effects of climate change and the benefits of mitigation. 1 However, health professionals also require a good knowledge base to be trusted advocates. Unlike the effects of smoking or HIV/AIDS, the health effects of a changing climate do not feature strongly in medical school curricula. Surveys have indicated that only six of 33 UK medical schools teach climate and health topics, and only one institution includes these topics as core teaching.2 A high demand for global health teaching is found among medical students internationally. 3 One frequent question is how best to integrate climate and health topics into the already crowded undergraduate curricula. 4 Free resources such as Sustainable Healthcare Education, and BMJ E-Learning are good examples of how integrated case-based teaching could work.5,6 We call on medical schools, The General Medical Council, and the Royal Colleges to incorporate climate and health topics into undergraduate and postgraduate education. Tackling climate change could be the greatest global health opportunity of the 21st century, but only if we equip tomorrow’s health professionals with the knowledge to take up their role as advocates and leaders. We declare no competing interests.
*Jessica Lugsdin, Caroline Hook
[email protected] Newcastle Univerity, Newcastle upon Tyne, Tyne and Wear NE1 7RU, UK 1
Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386: 1861–914.
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Braithwaite I, Mortimer F, Thompson T, et al. UK medical school teaching on sustainability, climate & health. Oxford: Centre for Sustainable Healthcare; 2012. http://sustainablehealthcare. org.uk/sites/default/files/she_scc_case_studies. pdf (accessed June 26, 2015). Göpfert A, Mohamedbhai H, Mise J, et al. Do medical students want to learn about global health? Glob Health Action 2014; 7: 23943. Bell E. Climate change: what competencies and which medical education and training approaches? BMC Med Educ 2010; 10: 31. Centre for Sustainable Healthcare. Sustainable healthcare education: resources. http:// sustainablehealthcare.org.uk/sustainablehealthcare-education/resources (accessed June 27, 2015). BMJ Learning. Climate change and health: the basics of climate science and the impacts of climate change. http://learning.bmj.com/ learning/module-intro/climate-change-healthscience-impacts-.html?moduleId=10017515 (accessed June 27, 2015).
Imtek Imagineering/Masterfile/Corbis
countries.” The Commission could have called for a stronger public healthdriven push for equitable climate financing and technology transfer to enable “[rapid expansion] of access to renewable energy in low-income and middle-income countries”. Third, we caution on the outright support for carbon pricing as an approach to mitigation. While such measures discourage carbon emissions, they have been shown to potentially increase income inequality and in turn, exacerbate health inequality.5 The public health community should further examine the potential health impacts of this and other proposed market mechanisms to emission reduction. Indeed, the report reflects the public health community’s dissatisfaction towards global climate inaction. The community should never be satisfied even with a 2-degree temperature rise limit; we should be more ambitious than that, in the name of human survival.
We were happy to read the Lancet Commission Report of policy response to protect public health from climate change,1 and we would like to point out the sustainability of climate finance from the perspective of China. Clearly, huge investment is needed for mitigation of and adaptation to climate change effects in the world’s largest emerging country. The Chinese Government is aware of this challenge and has been taking action. Under the 12th Five Year Plan for China (2011–15),2 the government estimated a need for almost US$800 billion of investment in clean technology, renewable energy, and environmental protection. In 2012, an estimated $270·7 billion of public funds were spent on these initiatives.3 The Chinese Government has also established 190 emerging industry investment funds, managing a total of $8·6 billion since 2013, and $2·1 billion (25%) of these funds are used in climate related fields.4 H o w e v e r, n o n - g o v e r n m e n t sources of investment are limited. Recent estimations suggest that in 2012, finance from the government accounted for almost 20% of the total volume of nationwide climate-related investment in China, by contrast with countries such as the UK and Germany where government spending was less than 5% of total investment.3 431
