Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Over 200 health journals urge world leaders to tackle “catastrophic harm”. Read the full editorial below.

Wealthy nations must do much more, much faster

The UN General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.

Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.[1] The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.[2, 3] Despite the world’s necessary preoccupation with covid-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.

Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.

The risks to health of increases above 1.5°C are now well established.[2] Indeed, no temperature rise is “safe.” In the past 20 years, heat related mortality among people aged over 65 has increased by more than 50%.[4] Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.[5, 6] Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities, and those with underlying health problems.[2, 4]

Global heating is also contributing to the decline in global yield potential for major crops, falling by 1.8-5.6% since 1981; this, together with the effects of extreme weather and soil depletion, is hampering efforts to reduce undernutrition.[4] Thriving ecosystems are essential to human health, and the widespread destruction of nature, including habitats and species, is eroding water and food security and increasing the chance of pandemics.[3,7,8]

The consequences of the environmental crisis fall disproportionately on those countries and communities that have contributed least to the problem and are least able to mitigate the harms. Yet no country, no matter how wealthy, can shield itself from these impacts. Allowing the consequences to fall disproportionately on the most vulnerable will breed more conflict, food insecurity, forced displacement, and zoonotic disease—with severe implications for all countries and communities. As with the covid-19 pandemic, we are globally as strong as our weakest member.

Rises above 1.5°C increase the chance of reaching tipping points in natural systems that could lock the world into an acutely unstable state. This would critically impair our ability to mitigate harms and to prevent catastrophic, runaway environmental change.[9, 10]

Global targets are not enough

Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world’s land and oceans by 2030. [11]

These promises are not enough. Targets are easy to set and hard to achieve. They are yet to be matched with credible short and longer term plans to accelerate cleaner technologies and transform societies. Emissions reduction plans do not adequately incorporate health considerations.[12] Concern is growing that temperature rises above 1.5°C are beginning to be seen as inevitable, or even acceptable, to powerful members of the global community.[13] Relatedly, current strategies for reducing emissions to net zero by the middle of the century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the atmosphere.[14, 15]

This insufficient action means that temperature increases are likely to be well in excess of 2°C,[16] a catastrophic outcome for health and environmental stability. Critically, the destruction of nature does not have parity of esteem with the climate element of the crisis, and every single global target to restore biodiversity loss by 2020 was missed.[17] This is an overall environmental crisis.[18]

Health professionals are united with environmental scientists, businesses, and many others in rejecting that this outcome is inevitable. More can and must be done now—in Glasgow and Kunming—and in the immediate years that follow. We join health professionals worldwide who have already supported calls for rapid action.[1, 19]

Equity must be at the centre of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed [20, 21] and reaching net-zero emissions before 2050. Similar targets and emergency action are needed for biodiversity loss and the wider destruction of the natural world.

To achieve these targets, governments must make fundamental changes to how our societies and economies are organised and how we live. The current strategy of encouraging markets to swap dirty for cleaner technologies is not enough. Governments must intervene to support the redesign of transport systems, cities, production and distribution of food, markets for financial investments, health systems, and much more. Global coordination is needed to ensure that the rush for cleaner technologies does not come at the cost of more environmental destruction and human exploitation.

Many governments met the threat of the covid-19 pandemic with unprecedented funding. The environmental crisis demands a similar emergency response. Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes. These include high quality jobs, reduced air pollution, increased physical activity, and improved housing and diet. Better air quality alone would realise health benefits that easily offset the global costs of emissions reductions. [22]

These measures will also improve the social and economic determinants of health, the poor state of which may have made populations more vulnerable to the covid-19 pandemic. [23] But the changes cannot be achieved through a return to damaging austerity policies or the continuation of the large inequalities of wealth and power within and between countries.

Cooperation hinges on wealthy nations doing more

In particular, countries that have disproportionately created the environmental crisis must do more to support low and middle income countries to build cleaner, healthier, and more resilient societies. High income countries must meet and go beyond their outstanding commitment to provide $100bn a year, making up for any shortfall in 2020 and increasing contributions to and beyond 2025. Funding must be equally split between mitigation and adaptation, including improving the resilience of health systems.

Financing should be through grants rather than loans, building local capabilities and truly empowering communities, and should come alongside forgiving large debts, which constrain the agency of so many low income countries. Additional funding must be marshalled to compensate for inevitable loss and damage caused by the consequences of the environmental crisis.

As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world. Alongside acting to reduce the harm from the environmental crisis, we should proactively contribute to global prevention of further damage and action on the root causes of the crisis. We must hold global leaders to account and continue to educate others about the health risks of the crisis. We must join in the work to achieve environmentally sustainable health systems before 2040, recognising that this will mean changing clinical practice. Health institutions have already divested more than $42bn of assets from fossil fuels; others should join them.[4]

The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1.5°C and to restore nature. Urgent, society-wide changes must be made and will lead to a fairer and healthier world. We, as editors of health journals, call for governments and other leaders to act, marking 2021 as the year that the world finally changes course.

Acknowledgments

This editorial is being published simultaneously in many international journals. Please see the full list here: https://www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial-september-2021

Footnotes

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: FG serves on the executive committee for the UK Health Alliance on Climate Change and is a trustee of the Eden Project. RS is the chair of Patients Know Best, has stock in UnitedHealth Group, has done consultancy work for Oxford Pharmagenesis, and is chair of the Lancet commission on the value of death.

📃 Full list of authors and signatories to climate emergency editorial September 2021

This editorial is being published simultaneously in the following journals (alphabetical order)

  1. Acta Orthopaedica et Traumatologica Turcica
  2. Advances in Nursing Science
  3. Advances in Nutrition
  4. African Journal of Laboratory Medicine
  5. Afro-Egyptian Journal of Infectious and Endemic Diseases
  6. Age and Ageing
  7. Alcohol and Alcoholism
  8. Allergy
  9. Alpha Psychiatry
  10. American Journal of Clinical Pathology
  11. American Journal of Health-System Pharmacy
  12. American Journal of Hypertension
  13. American Society of Microbiology
  14. Animal Bioscience
  15. Annals of African Surgery
  16. Annals of Behavioral Medicine
  17. Annals of Oncology
  18. Annals of Global Health
  19. Annals of the Rheumatic Diseases
  20. Annals of the Royal College of Surgeons of England
  21. Archives of Disease in Childhood
  22. Archives of the Turkish Society of Cardiology
  23. Asia Pacific Journal of Public Health
  24. Balkan Medical Journal
  25. Belgian Journal of Medicine
  26. Biosis: Biological Systems
  27. BJOG
  28. BMJ Case Reports
  29. BMJ Evidence-Based Medicine
  30. BMJ Global Health
  31. BMJ Health & Care Informatics
  32. BMJ Innovations
  33. BMJ Leader
  34. BMJ Military Health
  35. BMJ Nutrition, Prevention & Health
  36. BMJ Open
  37. BMJ Open Gastroenterology
  38. BMJ Open Ophthalmology
  39. BMJ Open Quality
  40. BMJ Open Respiratory Research
  41. BMJ Open Science
  42. BMJ Open Sport & Exercise Medicine
  43. BMJ Paediatrics Open
  44. BMJ Quality & Safety
  45. BMJ Sexual & Reproductive Health
  46. BMJ Supportive & Palliative Care
  47. BMJ Surgery, Interventions, & Health Technologies
  48. Bosnian Journal of Basic Medical Sciences
  49. Brain
  50. Brain Communications
  51. British Dental Journal
  52. British Journal of Clinical Pharmacology
  53. British Journal of General Practice
  54. British Journal of Ophthalmology
  55. British Journal of Sports Medicine
  56. British Medical Bulletin
  57. Bulletin of the World Health Organization
  58. Cadernos de Saúde Pública
  59. Canadian Journal of Respiratory Therapy
  60. Canadian Medical Association Journal
  61. Cardiovascular Research
  62. Caribbean Medical Journal
  63. Chinese Science Bulletin
  64. CIN: Computers, Informatics, Nursing
  65. Clinical Medicine
  66. Croatian Medical Journal
  67. Crohn’s & Colitis 360
  68. Cureus Journal of Medical Science
  69. Current Developments in Nutrition
  70. Danish Medical Journal
  71. Diseases of the Colon & Rectum
  72. Dutch Journal of Medicine
  73. East African Medical Journal
  74. EBioMedicine
  75. EClinicalMedicine
  76. Emergency Medicine Journal
  77. EP Europace
  78. European Heart Journal
  79. European Heart Journal – Acute Cardiovascular Care
  80. European Heart Journal – Cardiovascular Imaging
  81. European Heart Journal – Case Reports
  82. European Heart Journal – Digital Health
  83. European Heart Journal – Quality of Care and Clinical Outcomes
  84. European Heart Journal – Cardiovascular Pharmacotherapy
  85. European Journal of Cardio-Thoracic Surgery
  86. European Journal of Cardiovascular Nursing
  87. European Journal of Hospital Pharmacy
  88. European Journal of Preventive Cardiology
  89. European Journal of Public Health
  90. Evidence-Based Mental Health
  91. Evidence-Based Nursing
  92. Family Medicine and Community Health
  93. Family Practice
  94. Finnish Medical Journal
  95. Frontline Gastroenterology
  96. Gaceta Sanitaria
  97. Gastrointestinal Nursing
  98. General Psychiatry
  99. Global Health Action
  100. Global Heart
  101. Global Journal of Medicine and Public Health
  102. Health Policy and Planning
  103. Health Promotion International
  104. Health Promotion Journal of Australia
  105. Heart
  106. Huisarts en wetenschap
  107. Human Molecular Genetics
  108. Human Reproduction
  109. IJQHC Communications
  110. Indian Journal of Medical Ethics
  111. Indian Journal of Medical Research
  112. Inflammatory Bowel Diseases
  113. Injury Prevention
  114. Innovation in Aging
  115. Integrated Healthcare Journal
  116. International Journal of Epidemiology
  117. International Journal of Gynaecology & Obstetrics
  118. International Journal of Gynecological Cancer
  119. International Journal of Health Policy and Management
  120. International Journal of Integrated Care
  121. International Journal of Medical Students
  122. International Journal of Nursing Studies
  123. International Journal of Older People Nursing
  124. International Journal of Pharmacy Practice
  125. International Nursing Review
  126. JAMIA Open
  127. JMIR Public Health & Surveillance
  128. JNCI Cancer Spectrum
  129. Journal of Child Health Care
  130. Journal of Clinical Pathology
  131. Journal of Crohn’s and Colitis
  132. Journal of Epidemiology & Community Health
  133. Journal of Health and Caring Sciences
  134. Journal of Health, Population and Nutrition
  135. Journal of Medical Ethics
  136. Journal of Medical Genetics
  137. Journal of Medical Imaging and Radiation Sciences
  138. Journal of Nepal Paediatric Society
  139. Journal of Neurology Neurosurgery & Psychiatry
  140. Journal of Open Health Data
  141. Journal of Pharmacuetical Health Services Research
  142. Journal of Pharmacy and Pharmacology
  143. Journal of Public Health
  144. Journal of Surgical Case Reports
  145. Journal of Surgical Protocols and Research Methodologies
  146. Journal of the American Medical Informatics Association
  147. Journal of the Medical Association of Thailand
  148. Journal of the National Cancer Institute
  149. Journal of the Norwegian Medical Association
  150. Journal of the Royal Society of Medicine
  151. Journal of Travel Medicine
  152. Journal of Tropical Pediatrics
  153. Journal of Turkish Society of Microbiology
  154. Kafkas Universitesi Veteriner Fakültesi Dergisi
  155. Khyber Medical University Journal
  156. Lab Medicine
  157. Medical Humanities
  158. Medical Journal of Australia
  159. Medical Mycology
  160. Medwave
  161. Nephrology Dialysis Transplantation
  162. Neuro-Oncology Advances
  163. Neuro-Oncology Practice
  164. Neurology
  165. New England Journal of Medicine
  166. Nicotine & Tobacco Research
  167. Nurse Author & Editor
  168. Nursing Inquiry
  169. Nutrition Reviews
  170. Occupational and Environmental Medicine
  171. Occupational Medicine
  172. Oxford Open Climate Change
  173. Oxford Open Immunology
  174. Pacific Rim Journal of International Nursing Research
  175. Paediatrics & Child Health
  176. Palliative Medicine
  177. Pan American Journal of Public Health
  178. Pediatric Infectious Disease Society of the Philippines Journal
  179. Pediatric Nursing
  180. The Pharmaceutical Journal
  181. PLOS Medicine
  182. Postgraduate Medical Journal
  183. Psychiatry and Clinical Psychopharmacology
  184. PTJ: Physical Therapy & Rehabilitation Journal
  185. Revista de la Facultad de Medicina Humana
  186. Revista de Saúde Pública
  187. Rheumatology
  188. RMD Open
  189. Schizophrenia Bulletin
  190. Schizophrenia Bulletin Open
  191. Sexually Transmitted Infections
  192. SLEEP
  193. SLEEP Advances
  194. Stroke and Vascular Neurology
  195. The American Journal of Clinical Nutrition
  196. The BMJ
  197. The Gerontologist
  198. The Journal of Climate Change and Health
  199. The Journal of Nutrition
  200. The Journals of Gerontology, Series A
  201. The Lancet
  202. The Lancet Child & Adolescent Health
  203. The Lancet Global Health
  204. The Lancet Microbe
  205. The Lancet Planetary Health
  206. The Lancet Psychiatry
  207. The Lancet Public Health
  208. The Lancet Regional Health – Americas
  209. The Lancet Regional Health – Europe
  210. The Lancet Regional Health – Western Pacific
  211. The National Medical Journal of India
  212. The Pan-American Journal of Ophthalmology
  213. Thorax
  214. Tobacco Control
  215. Translational Behavioral Medicine
  216. Tropical Journal of Pharmaceutical Research
  217. Turkish Archives of Otorhinolaryngology
  218. Turkish Archives of Pediatrics
  219. Turkish Journal of Anaesthesiology and Reanimation
  220. Turkish Journal of Biochemistry
  221. Turkish Journal of Cardiovascular Nursing
  222. Turkish Journal of Orthodontics
  223. Turkish Thoracic Journal
  224. Veterinary Record
  225. VOICE
  226. Western Journal of Emergency Medicine
  227. Women’s Healthcare: A Clinical Journal for NPs
  228. World Journal of Pediatric Surgery

In addition, the following journals are supporting the editorial (but are not publishing)

  1. American Family Physician
  2. International Journal of Cancer
  3. Journal of Manipulative and Physiological Therapeutics
  4. Pakistan Journal of Medical Sciences
  5. Philippine Journal of Otolaryngology Head and Neck Surgery
  6. The Lancet Digital Health
  7. The Lancet Gastroenterology & Hepatology
  8. The Lancet Haematology
  9. The Lancet Healthy Longevity
  10. The Lancet HIV
  11. The Lancet Respiratory Medicine
  12. The Lancet Rheumatology
  13. Open Journal of Bioresources
  14. Veterinary Anaesthesia and Analgesia
  15. Journal of Advanced Nursing
  16. Journal of Clinical Nursing
  17. Nursing Open
  18. Revista Venezolana de Salud Pública
  19. Revista Médica del Uruguay
  20. Revista Argentina de Salud Pública
  21. GeoHealth
  22. American Geophysical Union Journals
  23. Methodist DeBakey Cardiovascular Journal

BMJ 2021;374:n1734 (CC BY 4.0)

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