The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises

By N. Watts, Markus Amann, N. Arnell, S. Ayeb-Karlsson, J. Beagley, K. Belesova, M. Boykoff, P. Byass, W. Cai, D. Campbell-Lendrum and 77 more. The Lancet, 2020

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Executive summary The Lancet Countdown is an international collaboration established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. This report represents the findings and consensus of the 35 leading academic institutions and UN agencies that make up the Lancet Countdown, and draws on the expertise of climate scientists, geographers, engineers, experts in energy, food, and transport, economists, social, and political scientists, data scientists, public health professionals, and doctors. The emerging health profile of the changing climate 5 years ago, countries committed to limit global warming to “well below 2°C” as part of the landmark Paris Agreement. 5 years on, global carbon dioxide (CO2) emissions continue to rise steadily, with no convincing or sustained abatement, resulting in a rise in the global average temperature of 1·2°C. Indeed, the five hottest years on record have occurred since 2015. The changing climate has already produced considerable shifts in the underlying social and environmental determinants of health at the global level. Indicators in all domains of section 1 (climate change impacts, exposures, and vulnerabilities) are worsening. Concerning, and often accelerating, trends were seen for each of the human symptoms of climate change monitored, with the 2020 indicators presenting the most worrying outlook reported since the Lancet Countdown was first established. These effects are often unequal, disproportionately impacting populations who have contributed the least to the problem. This fact reveals a deeper question of justice, whereby climate change interacts with existing social and economic inequalities and exacerbates longstanding trends within and between countries. An examination of the causes of climate change revealed similar issues, and many carbon-intensive practices and policies lead to poor air quality, poor food quality, and poor housing quality, which disproportionately harm the health of disadvantaged populations. Vulnerable populations were exposed to an additional 475 million heatwave events globally in 2019, which was, in turn, reflected in excess morbidity and mortality (indicator 1.1.2). During the past 20 years, there has been a 53·7% increase in heat-related mortality in people older than 65 years, reaching a total of 296 000 deaths in 2018 (indicator 1.1.3). The high cost in terms of human lives and suffering is associated with effects on economic output, with 302 billion h of potential labour capacity lost in 2019 (indicator 1.1.4). India and Indonesia were among the worst affected countries, seeing losses of potential labour capacity equivalent to 4–6% of their annual gross domestic product (indicator 4.1.3). In Europe in 2018, the monetised cost of heat-related mortality was equivalent to 1·2% of regional gross national income, or the average income of 11 million European citizens (indicator 4.1.2). Turning to extremes of weather, advancements in climate science allow for greater accuracy and certainty in attribution; studies from 2015 to 2020 have shown the fingerprints of climate change in 76 floods, droughts, storms, and temperature anomalies (indicator 1.2.3). Furthermore, there was an increase in the number of days people were exposed to a very high or extremely high risk of wildfire between 2001–04 and 2016–19 in 114 countries (indicator 1.2.1). Correspondingly, 67% of global cities surveyed expected climate change to seriously compromise their public health assets and infrastructure (indicator 2.1.3). The changing climate has downstream effects, impacting broader environmental systems, which in turn harm human health. Global food security is threatened by rising temperatures and increases in the frequency of extreme events; global yield potential for major crops declined by 1·8–5·6% between 1981 and 2019 (indicator 1.4.1). The climate suitability for infectious disease transmission has been growing rapidly since the 1950s, with a 15·0% increase for dengue caused by Aedes albopictus in 2018, and regional increases for malaria and Vibrio bacteria (indicator 1.3.1). Projecting forward, based on current populations, between 145 million people and 565 million people face potential inundation from rising sea levels (indicator 1.5). Despite these clear and escalating signs, the global response to climate change has been muted and national efforts continue to fall short of the commitments made in the Paris Agreement. The carbon intensity of the global energy system has remained almost flat for 30 years, with global coal use increasing by 74% during this time (indicators 3.1.1 and 3.1.2). The reduction in global coal use that had been observed since 2013 has now reversed for the past 2 consecutive years: coal use rose by 1·7% from 2016 to 2018. The health burden is substantial—more than 1 million deaths occur every year as a result of air pollution from coal-fired power, and some 390 000 of these deaths were a result of particulate pollution in 2018 (indicator 3.3). The response in the food and agricultural sector has been similarly concerning. Emissions from livestock grew by 16% from 2000 to 2017, with 93% of emissions coming from ruminant animals (indicator 3.5.1). Likewise, increasingly unhealthy diets are becoming more common worldwide, with excess red meat consumption contributing to some 990 000 deaths in 2017 (indicator 3.5.2). 5 years on from when countries reached an agreement in Paris, a concerning number of indicators are showing an early, but sustained, reversal of previously positive trends identified in past reports (indicators 1.3.2, 3.1.2, and 4.2.3). A growing response from health professionals Despite little economy-wide improvement, relative gains have been made in several key sectors: from 2010 to 2017, the average annual growth rate in renewable energy capacity was 21%, and low-carbon electricity was responsible for 28% of capacity in China in 2017 (indicator 3.1.3). However, the indicators presented in the 2020 report of the Lancet Countdown suggest that some of the most considerable progress was seen in the growing momentum of the health profession’s engagement with climate change globally. Doctors, nurses, and the broader profession have a central role in health system adaptation and mitigation, in understanding and maximising the health benefits of any intervention, and in communicating the need for an accelerated response. In the case of adaptation in national health systems, this change is underway. Impressively, health services in 86 countries are now connected with their equivalent meteorological services to assist in health adaptation planning (indicator 2.2). At least 51 countries have developed plans for national health adaptation, and global spending in health adaptation rose to 5·3% of all adaptation spending in 2018–19, reaching US$18·4 billion in 2019 (indicators 2.1.1 and 2.4). The health-care sector, which was responsible for 4·6% of global greenhouse gas emissions in 2017, is taking early but important steps to reduce its own emissions (indicator 3.6). In the UK, the National Health Service has declared an ambition to deliver a net-zero health service as soon as possible, building on a decade of impressive progress in reducing delivery of care emissions by 57% since 1990, and by 22% when considering the service’s supply chain and broader responsibilities. Elsewhere, the Western Australian Department of Health used its 2016 Public Health Act to conduct Australia’s first climate and health inquiry, and the German Federal Ministry of Health has established a dedicated department on health protection and sustainability responsible for climate-related matters. This progress is becoming more evenly distributed around the world, with 73% of countries making explicit references to health and wellbeing in their Nationally Determined Contributions under the Paris Agreement, and 100% of countries in the South-East Asia and Eastern Mediterranean regions doing so (indicator 5.4). Similarly, least-developed countries and small island developing states are providing increasing global leadership within the UN General Debate on the connections between health and climate change (indicator 5.4). Individual health professionals and their associations are also responding well, with health institutions committing to divest more than $42 billion worth of assets from fossil fuels (indicator 4.2.4). In academia, the publication of original research on health and climate changed has increased by a factor of eight from 2007 to 2019 (indicator 5.3). These shifts are being translated into the broader public discourse. From 2018 to 2019, the coverage of health and climate change in the media increased by 96% world-wide, outpacing the increased coverage of climate change overall, and reaching the highest observed point to date (indicator 5.1). Just as it did with advancements in sanitation and hygiene and with tobacco control, growing and sustained engagement from the health profession during the past 5 years is now beginning to fill a crucial gap in the global response to climate change. The next 5 years: a joint response to two public health crises Dec 12, 2020, will mark the anniversary of the 2015 Paris Agreement, with countries set to update their national commitments and review these commitments every 5 years. These next 5 years will be pivotal. To reach the 1·5°C target and limit temperature rise to “well below 2°C”, the 56 gigatonnes of CO2 equivalent (GtCO2e) currently emitted annually will need to drop to 25 GtCO2e within only 10 years (by 2030). In effect, this decrease will require a 7·6% reduction ev

Subfields: General Health Professions, Health, Toxicology and Mutagenesis

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In General Health Professions

  1. Andrea C. Tricco

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