We are burning up and drowning: Plan, act, do: Health’s job in the climate change emergency

"It’s depressing to consider, but I suspect the deluge in Auckland will prove to be far more consequential to the well-off’s awareness of climate change than news that Kaitaia or Westport is under water, again…”

Inspired by a tweet from US essayist Henry Wismayer about the demise of skiing in the European Alps, I wrote the above text message to colleagues in Westport and Kaitaia on 28 January 2023, just after Auckland City had been inundated.

Two weeks later, as I write, New Zealanders must get their heads around the trail of devastation and disruption wreaked across the North Island by Tropical Cyclone Gabrielle.

Tragically, as many are finding, these events cost lives. They induce huge trauma in those who have lost homes and livelihoods, an experience many, understandably, will struggle ever to get over.

Television and social feeds are full of the impacts on our infrastructure, and everything else that relies on that to function. Indeed, on almost every level, these weather events are a human tragedy.

It bears repetition: the intensified weather events over recent weeks are what man-made climate change looks like in real time.

With global temperatures sitting around 1.1 degrees above pre-industrial levels, it is deemed that warming to around 1.5 degrees is the limit before many parts of the globe become unliveable.

But carbon dioxide levels are still climbing and a number of negative environmental tipping points are being crossed. The UN in November advised that the world has no credible pathway to achieving the 1.5-degree target, and a future nearer 3 degrees of warming is most likely on our current trajectory.

Okay, we’re in a fix. Why are these issues for clinicians?

In case it is not completely clear, the climate emergency is a healthcare emergency.

If you signed up to the Hippocratic Oath, then matters around climate change fall neatly into core business, on at least two counts – “do no harm” and “do good”.

Explicitly, climate affects health in three broad ways:

Direct effects – drownings, burns and trauma are part of a climate-changed future. Cardiovascular and mental health stress from (repeated) weather events are considerable and must be planned for. Air pollution from fossil fuel and wood burning (vehicles, gas hobs and household heating) is increasing respiratory morbidity and mortality.

Zoonoses – viral diseases like Chikungunya, dengue fever, Japanese encephalitis, Ross River, West Nile and Zika, as well as malaria, are all spreading around the Pacific and knocking at our door.

Food and water insecurity – weather events, changing weather patterns and precipitous biodiversity loss will increasingly cause insecurity in staple foods and water supplies. The current damage to the national food basket in Hawke’s Bay is only just being recognised. Again, these issues need to be planned for.

Many of us are fatigued and this is the last thing we want to deal with. I am tired, too. But the last few weeks have shown that leaving these challenges in the too-hard box is not an option. The climate health emergency is not going away and is only going to get worse.

On the positive side, taking action involves choosing how severe things get in the future and what kind of future we all want to live in.

We cannot leave any groups behind. Climate is going to be the lens through which all our health and social injustices get magnified.

Add perhaps 80cm of sea level rise by the end of this century and combine it with a storm surge like the one that has just passed, and serious questions will arise from inundation of many Kiwi coastal towns and cities. Indeed, it may come to be that issues around insurance are where “the rubber meets the road”.

Understanding the intersectional nature of climate injustices – that is, how injustices compound in certain groups – and finding equitable solutions for all is going to be one of the most challenging aspects.

Part of the solution may well come through the transition to zero carbon and “polluter pays”.

Many corporations have made fantastic and immoral profits over recent years, not least the fossil fuel giants, all on the back of our “dependence”. Bold and clever financial measures could allow us to claw back billions from these profiteers, allowing us to build smart infrastructure and construct ways to level up society in the process.

The intensified weather events over recent weeks are what man-made climate change looks like in real time

The fixes fall into two interlocking processes:

Mitigation – reducing greenhouse gas emissions. New Zealand’s biggest sources of emissions are from transport and agriculture, with 40 per cent coming from methane alone. The independent Climate Action Tracker suggests New Zealand is “highly insufficient” when it comes to reducing our emissions as pledged internationally.

Collectively, three areas will likely make the most rapid differences:

• transition to electric vehicles and increased public transport use
• decarbonising agriculture, including mandating the use of “green” fertiliser, and
• transition to non-animal protein.

Adaptation – reducing the harmful effects of a warming planet. As we are seeing in real time since Gabrielle, our systems and built environment must become much more resilient to cope. This will include thorny discussions on water management. Additionally, rewilding various landscapes and greening our towns and cities to better dissipate heat and surface water may well be part of the solution.

Specific health-focused actions might include:

Transition to zero – healthcare occupies around 10 per cent of the national carbon budget, and this needs to be reduced to near zero by 2050. To achieve this, many aspects of practice will need to change from an illness to a wellness model. Efficiencies are apparent if you keep people fit and healthy in the first place. A sustainability unit within the health bureaucracy needs supercharging – ideally with robust links to the Ministry for Business, Innovation & Employment and Ministry for Primary Industries to ensure a coordinated approach to decarbonisation (with wellness as the focus). Consider a paradigm shift in hospital food often prepared in one place before it is transported (with a significant carbon footprint) to the regions. Instead, prepare and serve a non-animal protein with locally grown vegetables in local hospitals. End the purchasing of single-use surgical instruments and go back to sustainable autoclaving. Stop the use of metered dose inhalers and their propellants that are dozens of times more potent warming agents. For the same reason, develop a national plan to recycle anaesthetic gases.

Health training – medical, nursing and paramedicine education should add climate studies to their core curricula. GP practices, especially rural ones, need to be better integrated into community Civil Defence systems because getting to hospital, urgent care or even St John isn’t possible when roads are out and everywhere is overwhelmed. This should mean additional training in trauma, mass casualty triage and field management is made available.

Rural – a rural health college, run by rurally focused clinicians and catering for the demands of rural work in a warming world, is required and would help ensure consistency and parity. Training courses for rural hospital doctors, rural GPs and rural nurses need to be funded in their entirety, and jobs for those who qualify should pay enhanced salaries. This would significantly improve resilience in the workforce, and hence recruitment and retention in the areas most vulnerable to the climate/ health emergency.

Infrastructure – the process of building back smarter (not just better) should include difficult conversations about managed retreat, and an honest assessment of what health services can and cannot be provided in these communities is needed. I know from working rurally that these decisions often occur by stealth, remote from the community, leading to resentment and poor engagement. New infrastructure needs to consider patient and employee wellness as a way to mitigate and adapt to climate change.

Homes – our houses need to be better insulated, heated with energy-efficient heat pumps and fitted with induction hobs. Old homes can be retrofitted and codes for new builds can be mandated. Not only will this reduce energy use, and thus decarbonise, but it will also reduce the pollution and massive health impacts of wood burned for home heating and gas hobs.

Transport – let’s get people out of cars and onto their feet and bicycles, including e-bikes. To encourage this, large employers like Te Whatu Ora could adopt “salary sacrifice” schemes – that is, help employees pay for e-bikes via salary deductions. In the UK, Bike 2 Work has been running successfully for 20 years, giving users an average 30 per cent saving on bikes and gear. Christchurch, my hometown, should be a good candidate for the most cyclefriendly city in the Southern hemisphere, with the right incentives.

Leadership – given our place in the Pacific and the clear danger to many island nations, Aotearoa should be stepping up to provide support in the climate/health space, as well as giving consideration to what a future looks like for people who become stateless due to man-made climate change.

I have spent the bulk of my professional life in Aotearoa working rurally as a GP and rural hospital doctor. I have seen climate/health issues play out in Northland and the West Coast for years and, like many other aspects of healthcare in rural areas, they have been normalised.

I have until now been quietly campaigning on environmental issues affecting the rural areas since 2019.

I take no pleasure in seeing lives getting predictably ruined. It is sickening.

The words of British suffragist Millicent Fawcett apply: “Courage calls to courage everywhere, and its voice cannot be denied.”

We know what the solutions are – even kids know this. We have no more time to waste, let’s make Aotearoa sustainable, because it is the right thing to do.

Robin Barraclough is a specialist GP and locum doctor in rural New Zealand