Issue 6: State of Climate and Health
More than ever, health has been rising on the climate change agenda. For years, activists in the health community have been working to reframe the climate crisis not as an issue of drowning polar bears and endangered species, but as one deeply personal-- a health crisis. With the world reeling from the emotional and economic toll of COVID-19, that reframing is gaining traction. In 2020, 47% of world leaders commented on the health dimensions of climate change in their statements at the UN General Debate, a number double that of 2019. Driven by the COP26 Health Programme, 51 countries (including the US) recently formally committed to climate resistant health systems and/or sustainable low carbon health systems. Individual health systems are also joining decarbonization efforts; for example, UCSF, UC Irvine, and UC Davis have all signed on to the Race to Zero initiative, a global alliance committed to achieving net zero carbon emissions by 2050.

Research on the intersections between climate change and health has also soared in the past decade; studies on climate and health increased 11-fold from 2007 to 2020. This evidence is summarized annually in the Lancet Countdown Report, which represents the consensus of leading international researchers. Last year’s 6th annual report covers 44 health indicators, including 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. For those with limited reading time (or attention span), the report is also available as a U.S. brief (13 pages), as a summary for medical professionals (3 pages), and as various regional reports (shoutout to Naomi Beyeler on our Center team for leading the writing of many of these briefs). Below, we summarize select findings.
Dengue, drought, and disease
The first section of the report summarizes the most up-to-date evidence in five key climate and health areas: health and heat, health and extreme weather events, climate-sensitive infectious diseases, food security and undernutrition, and migration, displacement, and rising sea levels.
Heat-related deaths of people aged >65 in each country in 2019
Heat: Young children and older adults are especially vulnerable to the health effects of heat. In 2019, 345,000 adults aged >65 suffered heat-related deaths. Increasingly, people are experiencing temperatures in which it is unsafe to work, play, and exercise outside. From 1991 to 2020, daily hours of unsafe outdoor temperatures rose from 2.5 to 3.7 hours in low-HDI countries.

Extreme weather events: Drought and wildfires threaten large areas of the Earth’s surface, with up to a fifth of the global land surface affected by drought in 2020 and 72% of countries experiencing increased wildfire exposure compared to 20 years ago. In the Southwest U.S., the past two decades were the driest in centuries. Drought and wildfires have direct and indirect health effects via a number of pathways, including smoke/dust exposure and food and water insecurity (summarized above).
Change in climate suitability for infectious diseases

Infectious diseases: Climate change threatens global reductions in communicable disease, especially in low-HDI nations. Many infections are on the rise, as shown above, driven by changes in sea surface temperature and salinity (Vibrio), and mosquito habitat suitability (dengue and malaria).
Change in crop growth duration from 1980 to 2020 relative to the 1981-2010 global average

Food insecurity and undernutrition: Even as population grows, crop yield potentials are trending downwards due to rising temperatures. For example, there has been a 6% reduction in crop yield potential for maize compared to the 1981-2010 average. Every 1 degree Celsius increase in temperature translates into a 1.4% global increase in the probability of severe food insecurity. 
Migration: Sea levels are projected to rise up to 2m above current levels within 80 years, threatening the 570 million people who live within 5m of sea level. The resulting migration and displacement would have profound effects on livelihoods, healthcare access, and mental health.

Inequity Seeds Inequity
Colonialism and inequitable policies have resulted in disproportionate health harms for certain countries and communities. When analyses are stratified by HDI (a UN-defined index that captures life expectancy, education, and standard of living), lower HDI is correlated with higher morbidity and mortality almost across the board despite high-HDI countries contributing the most to climate change. At the individual level, people living below the poverty line, outdoor workers, incarcerated people, people of color, and historically redlined communities are disproportionately exposed to heat, as illustrated by the patient cases above. This is due to factors like the urban heat island effect, unsheltered working conditions, and lack of air conditioning access. Climate change therefore exacerbates existing inequalities.
Money talks but who is listening?
Image: Rappler

As demonstrated by the report, the health-related costs of continued fossil fuel combustion are enormous. For example, the 2018 California wildfires were responsible for an estimated $32 billion in health costs (and half of those health costs were for people residing outside of California). However, budget calculations for climate action rarely include these indirect health costs. Perhaps this is why 65 out of 84 countries reviewed for the report were still using public funds to subsidize fossil fuels. 
The buzzwords of the climate community: mitigation and adaptation
The Earth’s surface has already warmed 1.1 degrees Celsius relative to preindustrial levels. In order to meet the goals set by the Paris Agreement and prevent catastrophic, irreversible levels of global warming, we will need to cut greenhouse gas emissions by half by mid-century. To do this, it is critical that we include health costs and climate action co-benefits in cost-benefit calculations, push for divestment from fossil fuels, especially in the healthcare sector, and continue to raise alarm among healthcare professionals.

Regardless of the steps we take today, health systems and human health will remain vulnerable to the threats posed by climate change for the foreseeable future. However, only 52% of the 91 countries assessed have national health and climate change plans in place. Partially, this is due to a climate-health financing gap indicating a lack of investment in building resilient health systems. The COVID-19 pandemic has illustrated how a lack of both planning and lack of funding can conspire to create wholly unprepared health systems when disaster strikes; with increasing climate disasters, it is important that access to essential services is not impaired. Building evidence-based, global coalitions like the Lancet Countdown Report team is one step in the right direction. 
Learn More

Check out the global Lancet Countdown website for interactive visuals and videos, news and events, and previous reports. U.S. specific data and visuals can be found here.
Do you have other resources you use to learn about climate change and solutions, action items that you’d like us to share, feedback or ideas for our newsletter? Please share them here!
This newsletter was created by Karly Hampshire and Alia Badawi, and edited by Sheri Weiser, Arianne Teherani, Jennifer Zakaras, and Naomi Beyeler, on behalf of the UC Center for Climate, Health, and Equity.