Results of Conference Day Survey

What do you expect from this conference?

• learn more about DRR
• meet people with whom to discuss and share these issues, gather useful knowledge and then take action! 

What is the most important climate change issue for you?

• the effects on poverty in the developing world
• migration
• effects on underlying causes of malnutrition
• homelessness/pregnancy/children
• injustice of distribution impact
• impact on livelihoods and wellbeing, especially for youth

Paul Yates - Freshfields

We encourage lawyers to use their professional experience to help people in need, through standing up for human rights and promoting access to justice.

If current predictions of the impact of climate change are accurate, we may well see a greater convergence of issues concerning health, human rights and access to justice.

Janice Hughes - President, Doctors of the World UK

Very big thanks to Freshfields, especially during this time of financial difficulty.

People at local levels are getting to grips with climate change issues, ie. deforestation, creeping of the Western Sahara desert. For example, Samburu in Kenya recently  suffered prolonged droughts but a week later there were flash floods.

It's very timely that we're having this meeting and bringing together the issues of climate change and health.

Doctors of the World has been working in developed and developing countries for 30 years. Earlier this month, Project:London won an excellence award, a reflection of the good work being done here in the UK.

The issue of healthcare and human rights isn't something that should just be there on paper, it should be a reality. We need to continue working with other organisations to raise awareness and engage actively.

We know that we will see more natural disasters. Doctors of the World UK was ready to send a team to Haiti to explore the feasibility of a disaster risk reduction (DRR) mission just before the earthquake struck. However, we will continue to focus on the DRR programme at a later date.

Measuring the Impact of Climate Change on Health - Andy Haines 

Climate change and health comes under different categories:

• adaptation
• mitigation
• improving public health

The study of climate change has expanded rapidly since the 1990s when it was still a minority interest. Some funders are taking it more seriously now but there is still a lack of adequate funding in this area.

The Intergovernmental Panel on Climate Change (IPCC) says there will be an upswing in temperature and it could be four degrees hotter by the end of the century than current levels. There is still a lot of uncertainty but if temperatures become higher, it will be more difficult to predict what will happen.

Positive feedback situation:

• ice melts will increase as it becomes warmer
• methane will also add to the warming
• the impact of warming on ecosystems could lead to some species being committed to extinction
• global ecosystems will be transformed by climate change

Semi-arid and arid places will be more exposed, resulting in more droughts. River levels could go down by 10-30%, with a large number of people living in areas with less water. Other related hot spots are southern Africa, Australia and Latin America. In northern Europe and Africa, there is likely to be an increase in precipitation and flooding.

These conditions will have a ranging impact on health and the economy. Small islands will be very susceptible to these changes.

We are already facing a global crisis. By 2025, more than half of the world's population will live under conditions of severe water stress. Water quality will go down in many parts of the world. Sea level is rising, largely because of thermal expansion.

How does climate change affect health outcomes?

• water-related disease
• food-borne diseases
• vector-borne diseases
• rise in malnutrition

If populations can adapt, they might be able to mitigate the above influences. But there are also limitations on how well they can adapt, based on other factors:

• migration
• global trading patterns

These create compounding uncertainties. On the other hand, one could argue that because of these uncertainties we have to take more care and act now.

What is unethical is not trying to do something about the situation. For example, a study of 16 sites in industrialised countries showed there was a direct impact between temperature and bacteria.

There is an empirical relationship between rainfall and diarrheal diseases. Changes in rainfall can lead to an increase in such diseases - up to a 4% rise in young children.

The heat wave in Europe and northern Africa in 2003 is another example of the direct effects of temperature. In Paris it was relatively healthy people who died, rather than elderly people.

A growing burden of climate disasters (although not all due to climate change), ie. Hurricane Mitch, which occurred in Central America in 1998, led to an increase in vector-borne, gastrointestinal and respiratory diseases. There was also increased poverty as many crops failed.

Malaria: In some parts of Africa, cases have gone down because of more desertification, but the latter isn't good for people. In other areas, such as east Africa, malaria is spreading into the highlands.

Dengue: The range of the disease is expanding due to climate change (not the only factor but certainly one).

Impact of flooding: Rise in infectious diseases, ie. cholera, respiratory diseases, hepatitis

and vector-borne diseases, ie. Rift Valley Fever

Flooding can also cause a lot of damage through secondary effects, ie. economic impact, long-term mental health effects, in developed and developing countries.

Carbon emitters are largely developed countries, but it is people in developing countries who will suffer. It is an ethical problem and one that hasn't really been publicly acknowledged.

How can we adapt to cope with climate change?

• physical limitations, ie. low-lying countries
• behavioural constraints
• technical limits, ie. lack of resources to build effective barriers

One could argue that we're in an economic recession, so it is expensive to put effective measures in place. However, investment in technology can have other beneficial affects, ie. Technology to reduce CHG emissions or develop energy efficient stoves, or the use of clean fuel will reduce air pollution.

Taking action will produce far more benefits than doing nothing. But we need a radical shift, not just small, incremental investments.

There has been a lot of misinformation about climate change. The IPCC made some mistakes, but that doesn't detract from the main issue. The scientific community is not well versed with the media, but it's not surprising given that the topic is so controversial.

The western model of development is not necessarily the best way to tackle climate change and health in low-income countries, but the question is who will take the lead.

Key References

Effective health protection in hot weather (Hajat, O'Connor, Kosatsky T, Lancet 2010)

The health co-benefits of climate change mitigation policies (Haines et al Lancet 2009)

PROJECTED EFFECT OF CLIMATE CHANGE ON DENGUE DISTRIBUTION (Hales et al., Lancet 2003)

Understanding the Link between Climate Change and Conflict - Susan Wright 

Climate change will contribute to new and varied health risks, especially in already fragile contexts that are unable to cope with health needs.

We already know that conflict is more likely to occur in places where peace has been built on unstable foundations. Climate change is putting pressure on causal factors of violence.

Climate change models are not perfect; there is a disconnect between national and regional. We don't know how existing stresses will affect climate change, but does this matter? Maybe the outcomes are more important?

Climate change on the escalation of violence: In low-lying island, there is more frequent flooding, more severe droughts etc, resulting in malnutrition. Shorter growing seasons in some places but longer ones in others all have an impact on the political economy and can lead to insecure livelihoods.

Different risks:

• political instability
• economic weaknesses, especially in agrarian states

We need to focus on good governance and integrated planning for adaptation to reduce risk and start peace building, as well as sustainable and non-violent means of adapting to the consequences of climate change.

Adaptation and mitigation shouldn't be seen as a competing interest.

Are we witnessing the rise of the environmental migrant? - Krishna Krishnamurthy

• The single most detrimental impact of climate change may be on human displacement (IPCC, 1990). Despite this issue being recognised 20 years ago, it has not received very much attention. There are no specific agencies dealing with environmental refugees, and the issue is often overlooked.
• Environmental change may lead to a disruption of livelihoods, eg. droughts, which may then trigger migration. Migration can thus be seen as a strategy for livelihood security.
• There is a clear need to strengthen both mitigation and adaptation strategies when it comes to climate change, and migration should be recognised as one form of adaptation and therefore be included in adaptation strategies. Seen as an adaptation strategy, migration should therefore be considered a solution, as opposed to a problem. Most countries, however, still perceive migration as the failure to adapt.
• It is very hard to predict the number of environmental migrants/refugees that we can expect; the best estimates vary from 200 million by 2050 (Myers, 1993) to 1 billion by 2050 (Lowell, 2007).
• Three main trends can be discerned from the study of environmental migrants/refugees; the migration tends to be temporary, voluntary and internal, though, of course, there are exceptions.
• How we conceptualise 'environmental migrants' - are they migrants or refugees? - is debated and will have clear implications for how they are dealt with on the international level. Perhaps a distinction can be made between those who flee their areas because of a rapid onset event (who we can consider migrants) and those who flee because of slow and ongoing processes like desertification (who we can consider refugees)

Understanding the impact of Climate Change on Migration - Jean Lambert , MEP

• Environmental change is a multifaceted phenomenon that is likely to affect us in a variety of ways. Examples include:
  • The proportion of land in constant drought is likely to increase from 2% to 10% by 2050
  • Less precipitation and increased intensity of weather hazards
  • Impacts on fish stocks
• When it comes to climate change, instead of asking what is being affected, we should rather ask what is not being affected
• Even the 'rich' countries, such as the European countries, the United States, and Australia are going to be effected by climate change. It is a common problem affecting all, and we should not therefore just 'build walls' when it comes to migration.
• In the media, environmental migrants/refugees are often portrayed as a threat to the UK, and the issue is very often framed in terms of 'us' protecting something from 'them'. This is likely to influence the way the issue is seen, and is already having an impact on the refugee population already here.

Issues of climate change and environmental refugees/migrants should be conceptualised in terms of human rights and common interests as opposed to national interests. 

Workshop: How can we influence policy that impacts health and climate change, right here in Europe - Dr. Robin Stott

How can we influence policy that impacts Health and Climate Change, right here in Europe?

The aim of the workshop is to explore the best way of influencing policy by asking what we should focus on, what kinds of partnerships and coalitions are needed, and what lessons we can learn from what has been done so far.

The target carbon emission per person should be 1.5 tonnes, in the richest nations; it is now 11-12 tonnes. Fossil fuel is predominantly being burnt by the rich north.

What can be done?

Health professional advocacy:

• inform - particularly the benefits of a fair-share society
• affirm - ensure that the organisation we are associated with has the same moral basis for advocacy.
• advocate - stress the need for a global framework along the lines of a contractual and convergent one to replace the Kyoto protocal.
• innovate - seek new institutional forums for delivery of the contractual and convergence framework.
• disseminate - recruit as many partnerships as possible.

These are not just health issues - everything is affected. Message needs to be incorporated into the main stream.

Change in population is dramatic if females have a right to reproductive education (female emancipation, gender equality).

Health professional are in a strong position. They have a duty to treat people, look at healthcare in the long term, are trusted and have contacts with those who will listen.

We should all support the climate change initiative - www.climateandhealth.org

Workshop: Understanding the link between climate change and health in the developing world, Dr Remco van de Pas

Health Sector Function - Disaster Risk Reduction in context

The role of the health sector in the climate change debate is quite a novelty. It is, therefore, important for humanitarian organisations to integrate their impact within their international programmes.

Workshop Objectives:

• for us all to share our own experiences and evidence of the impact of climate change on health in the developing world
• to highlight Disaster Risk Reduction (DRR) examples

Experiences in the field

In Sudan, Jo Grimshaw, one of our volunteers, witnessed malnutrition due to failing crops. Another participant also witnessed evidence of deforestation and soil erosion.

In Namibia, there was evidence of an increase in HIV/AIDS because of poor health systems, malnutrition and the spread of disease caused by unsustainable agriculture and recurrent flash floods.

Are these one off incidents or trends? How do we define the term "impact"?

Dr van de Pas highlighted the importance of interlocking causes that impact on health, particularly the inequalities increased by climate change, thus increasing vulnerability.

What trends have we experienced?

• disease has been affected, causing changes in patterns
• extreme weather conditions are more frequent, as experienced by DOW Netherlands in its Nargis programme in Burma.
• in Papua New Guinnea and East Africa, growing patterns of increasing food insecurity and malnutrition
• the implementation of health programmes have also been affected as targeted populations have migrated because of changing weather patterns. This forced migration has increased these people's vulnerability, placing them in insecure human settlements.

Is migration therefore a solution or is better family planning needed?

Disaster Risk Reduction: What is it about? Why?

People gave various suggestions:

• early warning systems

A country's levels of development, understanding and planning capacity strongly influenced the effectiveness of the early warning systems, using Haiti, Chile and Japan as examples.

• the importance of mixing science with policy and planning

We also mentioned the pivotal role of institutional memory, enabling countries to learn from previous catastrophes. This highlighted a problem with external involvement of international agencies that do not possess this memory.

• the importance of grass-roots capacity building in any intervention

What role is there for NGOs?

Dr van de Pas believes that NGOs should, if anything, only play a long-term infrastructural role, working together with other NGOs and government bodies.

Which stakeholders should be involved?

We stressed the importance of involving local NGOs and the local communities alongside government bodies. It was suggested that community coping strategies should be used, with early warning and planning systems.

Dr van de Pas also highlighted the fact that migration increased populations' vulnerability and limited its capacity to respond effectively, thus limiting migration as an efficient adaptation mechanism. It is important to keep people in their local communities to respond to a disaster.

Health sector functions to secure environmental health

We stressed the importance of primary healthcare and environmental education and promotion.

• Health protection norms and regulations
• Disease specific and integrated programmes
• Health facilities
• Outbreaks
• Good public health systems
• Highlighting health in inter-sectoral policies

Formulation of key messages

Our key aims were to:

• involve the local communities
• increase capacity building
• highlight the central role of education
• develop programmes that looked at strengthening existing health systems, rather than standalone programmes
• provide a long-term commitment

The next steps together, Sir Jonathon Porritt

About 20 years ago, there was not much debate on climate change, but it has grown enormously now. However, people can sometimes lose sense of direction, ie. being too focused on the meltdown in Copenhagen.

But getting an agreement is almost irrelevant because we need far greater action, such as changing processes and actions, if we're going to tackle climate change effectively.

Climate change has forced people to rethink the issue of limits on natural systems before they implode. Until the climate change debate came to a head, most governments would have happily carried on with current practices.

Climate change has now forced politicians to acknowledge that if you exceed limits, the system will implode.

This is the first time since the industrial revolution that we have had to reinternalise the system of limits because of biophysical limits. We're seeing a profound change in what progress needs to look like.

We have to think in a systems perspective, but also see the connectivity among different systems and how to find resilient solutions.

Climate change will either destroy everything or it will bring humanity together.

There is a disruptive notion of climate change. On the other hand, understanding and knowledge of technology is being shared around the world.

Moreover, the developing world is having a greater voice in the debate. China and India flexed their muscles in Copenhagen and a climate change treaty that isn't advantageous to those two won't happen.

Only 30% in the UK believe that climate change is manmade and happening. This is against 57% in China and 49% in India.

Therefore, we can't reach a worldwide solution that ignores the developing world. At the same time, we can't build a well high enough that will keep out climate change.

There is no other issue like climate change ie, global poverty hasn't persuaded everyone that we need to work together to solve the problem. Fewer people are committed to working together to solve social injustice.

We need to find a global agreement and drive shared solidarity - this is the most optimistic view of climate geopolitics. We can't sustain emotional commitment based on fear, guilt and anger. Therefore, we need to promote solutions and be alert to societal mechanisms.

The notion that people in the developing world wouldn't want to live like us and would rather find a better solution is a neopaternalistic view. Instead, we have to be alert to what is driving powerful economic forces in society. We have to work together, with the grains of aspiration in society.

If we only see climate change as climate change, rather than as a way of transforming lives, the message won't be as powerful.

30 years since Britain published a report on health inequalities, very little has changed. We now only spend 4% of total healthcare expenditure on prevention etc, compared with 5% 30 years ago.

People talk about a window of time to move from an inequitable, hydrocarbon way of life to a more equitable way of living. But can we make this transition work?

The world has never faced an issue like climate change before and although there is a lot to be, it is also a real opportunity to galvanise momentum and work together to find real solutions to this problem.