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

Call for emergency action to limit global temperature increases, restore biodiversity and protect... Open access Editorial Call for emergency action to limit global temperature increases, restore biodiversity and protect health 1 2 3 4 Lukoye Atwoli, Abdullah H Baqui, Thomas Benfield, Raffaella Bosurgi, 5 6 7 8 Fiona Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn- Langton, 9 10 11 12 Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, 13 14 15 8 Marcel GM Olde Rikkert, Eric J Rubin, Peush Sahni, Richard Smith, 16 17 18 Nicholas J Talley, Sue Turale, Damián Vázquez Wealthy nations must do much more, increased dehydration and renal function much faster. loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and To cite: Atwoli L, H Baqui A, The United Nations General Assembly cardiovascular and pulmonary morbidity Benfield T, et al. Call for 5 6 in September 2021 will bring countries and mortality. Harms disproportionately emergency action to limit together at a critical time for marshalling affect the most vulnerable, including chil- global temperature increases, collective action to tackle the global envi- restore biodiversity and protect dren, older populations, ethnic minorities, health. Fam Med Com Health ronmental crisis. They will meet again at poorer communities and those with under- 2021;9:e001369. doi:10.1136/ 2 4 the biodiversity summit in Kunming, China, lying health problems. fmch-2021-001369 and the climate conference (Conference Global heating is also contributing to the of the Parties (COP)26) in Glasgow, UK. Received 13 August 2021 decline in global yield potential for major Ahead of these pivotal meetings, we—the Accepted 16 August 2021 crops, falling by 1.8%–5.6% since 1981; editors of health journals worldwide—call this, together with the effects of extreme for urgent action to keep average global weather and soil depletion, is hampering temperature increases below 1.5°C, halt the efforts to reduce undernutrition. Thriving destruction of nature and protect health. ecosystems are essential to human health, Health is already being harmed by global and the widespread destruction of nature, temperature increases and the destruction including habitats and species, is eroding of the natural world, a state of affairs health water and food security and increasing the professionals have been bringing attention 3 7 8 chance of pandemics. to for decades. The science is unequivocal; The consequences of the environmental a global increase of 1.5°C above the prein- crisis fall disproportionately on those coun- dustrial average and the continued loss of tries and communities that have contrib- biodiversity risk catastrophic harm to health 2 3 uted least to the problem and are least that will be impossible to reverse. Despite able to mitigate the harms. Yet no country, the world’s necessary preoccupation with no matter how wealthy, can shield itself COVID-19, we cannot wait for the pandemic from these impacts. Allowing the conse- to pass to rapidly reduce emissions. © Author(s) (or their quences to fall disproportionately on the Reflecting the severity of the moment, employer(s)) 2021. Re- use most vulnerable will breed more conflict, permitted under CC BY. this editorial appears in health journals Published by BMJ. food insecurity, forced displacement and across the world. We are united in recog- For numbered affiliations see zoonotic disease, with severe implications nising that only fundamental and equitable end of article. for all countries and communities. As with changes to societies will reverse our current the COVID-19 pandemic, we are globally as trajectory. Correspondence to strong as our weakest member. The risks to health of increases above Mr Laurie Laybourn- Langton, UK Health Alliance on Climate Rises above 1.5°C increase the chance 1.5°C are now well established. Indeed, Change, C/O BMJ Publishing no temperature rise is ‘safe’. In the past 20 of reaching tipping points in natural Group, Tavistock Square, London systems that could lock the world into an years, heat- related mortality among people WC1H 9JR, UK; acutely unstable state. This would criti- aged over 65 has increased by more than laurie. laybourn@ ukhealthalliance. org 50%. Higher temperatures have brought cally impair our ability to mitigate harms Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 1 Open access and to prevent catastrophic, runaway environmental that the rush for cleaner technologies does not come 9 10 change. at the cost of more environmental destruction and human exploitation. Many governments met the threat of the COVID-19 GLOBAL TARGETS ARE NOT ENOUGH pandemic with unprecedented funding. The environ- Encouragingly, many governments, financial institu- mental crisis demands a similar emergency response. tions and businesses are setting targets to reach net- Huge investment will be needed, beyond what is being zero emissions, including targets for 2030. The cost of considered or delivered anywhere in the world. But renewable energy is dropping rapidly. Many countries such investments will produce huge positive health are aiming to protect at least 30% of the world’s land and economic outcomes. These include high- quality and oceans by 2030. jobs, reduced air pollution, increased physical activity, These promises are not enough. Targets are easy to and improved housing and diet. Better air quality set and hard to achieve. They are yet to be matched alone would realise health benefits that easily offset with credible short- term and longer- term plans to accel- the global costs of emissions reductions. erate cleaner technologies and transform societies. These measures will also improve the social and Emissions reduction plans do not adequately incorpo- economic determinants of health, the poor state of rate health considerations. Concern is growing that which may have made populations more vulnerable temperature rises above 1.5°C are beginning to be seen to the COVID-19 pandemic. But the changes cannot as inevitable, or even acceptable, to power ful members be achieved through a return to damaging austerity of the global community. Relatedly, current strategies policies or the continuation of the large inequalities of for reducing emissions to net zero by the middle of the wealth and power within and between countries. century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the 14 15 atmosphere. COOPERATION HINGES ON WEALTHY NATIONS DOING MORE This insufficient action means that temperature In particular, countries that have disproportionately increases are likely to be well in excess of 2°C, a cata- created the environmental crisis must do more to strophic outcome for health and environmental stability. support low- income and middle- income countries to Critically, the destruction of nature does not have parity build cleaner, healthier and more resilient societies. of esteem with the climate element of the crisis, and every High- income countries must meet and go beyond their single global target to restore biodiversity loss by 2020 was outstanding commitment to provide $100 billion a 17 18 missed. This is an overall environmental crisis. year, making up for any shortfall in 2020 and increasing Health professionals are united with environmental contributions to and beyond 2025. Funding must scientists, businesses and many others in rejecting that be equally split between mitigation and adaptation, this outcome is inevitable. More can and must be done including improving the resilience of health systems. now—in Glasgow and Kunming—and in the imme- Financing should be through grants rather than diate years that follow. We join health professionals loans, building local capabilities and truly empowering worldwide who have already supported calls for rapid communities, and should come alongside forgiving 1 19 action. large debts, which constrain the agency of so many Equity must be at the centre of the global response. low- income countries. Additional funding must be Contributing a fair share to the global effort means marshalled to compensate for inevitable loss and that reduction commitments must account for the damage caused by the consequences of the environ- cumulative, historical contribution each country has mental crisis. made to emissions, as well as its current emissions and As health professionals, we must do all we can to capacity to respond. Wealthier countries will have to aid the transition to a sustainable, fairer, resilient and cut emissions more quickly, making reductions by 2030 healthier world. Alongside acting to reduce the harm 20 21 beyond those currently proposed and reaching net- from the environmental crisis, we should proactively zero emissions before 2050. Similar targets and emer- contribute to global prevention of further damage and gency action are needed for biodiversity loss and the action on the root causes of the crisis. We must hold wider destruction of the natural world. global leaders to account and continue to educate To achieve these targets, governments must make others about the health risks of the crisis. We must join fundamental changes to how our societies and econ- in the work to achieve environmentally sustainable omies are organised and how we live. The current health systems before 2040, recognising that this will strategy of encouraging markets to swap dirty for mean changing clinical practice. Health institutions cleaner technologies is not enough. Governments have already divested more than $42 billion of assets must intervene to support the redesign of transport from fossil fuels; others should join them. systems, cities, production and distribution of food, The greatest threat to global public health is the markets for financial investments, health systems, and continued failure of world leaders to keep the global much more. Global coordination is needed to ensure temperature rise below 1.5°C and to restore nature. 2 Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 Open access greenhouse gas emission pathways, in the context of strengthening Urgent, society- wide changes must be made and will the global response to the threat of climate change, sustainable lead to a fairer and healthier world. We, as editors of development, and efforts to eradicate poverty, 2018. Available: https:// health journals, call for governments and other leaders www. ipcc. ch/ sr15/ 3 Intergovernmental Science-Policy platform on biodiversity and to act, marking 2021 as the year that the world finally ecosystem services. summary for policymakers: the global changes course. assessment report on biodiversity and ecosystem services, 2019. Available: https:// ipbes. net/ sites/ default/ files/ 2020- 02/ ipbes_ global_ assessment_ report_ summary_ for_ policymakers_ en. pdf Author affiliations 4 Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet East African Medical Journal, Nairobi, Kenya countdown on health and climate change: responding to converging Journal of Health, Population and Nutrition, Baltimore, Maryland, USA crises. Lancet 2021;397:129–70. Danish Medical Journal, Copenhagen, Denmark 5 Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of PLOS Medicine, Cambridge, UK climate change: an overview of systematic reviews. BMJ Open 2021;11:e046333. The BMJ, London, UK 6 6 Haines A, Ebi K. The imperative for climate action to protect British Dental Journal, London, UK health. N Engl J Med 2019;380:263–73. The Lancet, London, UK 7 United Nations Environment Programme and International Livestock UK Health Alliance on Climate Change, London, UK Research Institute. Preventing the next pandemic: zoonotic diseases Revista de Saúde Pública, São Paulo, Brazil and how to break the chain of transmission, 2020. Available: https:// International Journal of Nursing Studies, London, UK72d37324- 5089- 459c- 8f70- 271d19427cf2. filesusr. com/ ugd/ 056cf4_ b5b2 fc06 7f09 4dd3 b225 0cda 15c47acd. pdf CMAJ, Ottawa, Ontario, Canada 12 8 IPCC. Summary for policymakers. In: Climate change and land: Pharmaceutical Journal, London, UK an IPCC special report on climate change, desertification, land Dutch Journal of Medicine, Nijmegen, The Netherlands degradation, sustainable land management, food security, and NEJM, Boston, Massachusetts, USA greenhouse gas fluxes in terrestrial ecosystems, 2019. National Medical Journal of India, New Delhi, India 9 Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points— Medical Journal of Australia, Newcastle, New South Wales, Australia too risky to bet against. Nature 2019;575:592–5. 10 Wunderling N, Donges JF, Kurths J, et al. Interacting tipping elements International Nursing Review, Geneva, Switzerland 18 increase risk of climate domino effects under global warming. Earth Pan American Journal of Public Health, Washington, DC, USA Syst Dynam 2021;12:601–19. 11 High ambition coalition. Available: https://www. hacf orna ture andp Funding The authors have not declared a specific grant for this research from any eople. org funding agency in the public, commercial or not- for- profit sectors. 12 Global Climate and Health Alliance. Are national climate commitments enough to protect our health? Available: https:// clim Editor's note This editorial is being published simultaneously in many international atea ndhe alth alliance. org/ initiatives/ healthy- ndcs/ ndc- scorecards/ journals. Please see the full list here: https://www. bmj. com/ content/full- list- 13 Climate strikers: Open letter to EU leaders on why their new climate authors- and- signatories- climate- emergency- editorial- september- 2021 law is ‘surrender.’ Carbon Brief, 2020. Available: https://www. carbonbrief. org/ climate- strikers- open- letter- to- eu- leaders- on- why- Competing interests FG serves on the executive committee for the UK Health their- new- climate- law- is- surrender Alliance on Climate Change and is a trustee of the Eden Project. RS is the chair of 14 Fajardy M, Köberle A, MacDowell N, et al. “BECCS deployment: a Patients Know Best, has stock in UnitedHealth Group, has done consultancy work reality check.” Grantham Institute briefing paper 28, 2019. Available: for Oxford Pharmagenesis and is chair of the Lancet Commission on the Value of https://www. imperial. ac. uk/ media/ imperial- college/ grantham- Death. institute/ public/ publications/ briefing- papers/ BECCS- deployment- a- reality- check. pdf Patient and public involvement Patients and/or the public were not involved in 15 Anderson K, Peters G. The trouble with negative emissions. Science the design, or conduct, or reporting, or dissemination plans of this research. 2016;354:182–3. 16 Climate action tracker. Available: https:// climateactiontracker. org Patient consent for publication Not required. 17 Secretariat of the convention on biological diversity. global Provenance and peer review Commissioned; internally peer reviewed. biodiversity outlook 5, 2020. Available: https://www.cbd. int/ gbo5 18 Steffen W, Richardson K, Rockström J, et al. Sustainability. planetary Open access This is an open access article distributed in accordance with the boundaries: guiding human development on a changing planet. Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits Science 2015;347:1259855. others to copy, redistribute, remix, transform and build upon this work for any 19 UK Health Alliance. Our calls for action. Available: http://www. purpose, provided the original work is properly cited, a link to the licence is given, ukhealthalliance. org/ cop26/ and indication of whether changes were made. See: https:// creativecommons. org/ 20 Climate Action Tracker. Warming projections global update: may licenses/ by/ 4. 0/.2021. Available: https:// climateactiontracker. org/ documents/ 853/ CAT_ 2021- 05- 04_ Briefing_ Global- Update_ Climate- Summit- Momentum. pdf 21 United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020. 22 Markandya A, Sampedro J, Smith SJ, et al. Health co- benefits from REFERENCES 1 In support of a health recovery. Available: https://healthyr ecovery.net air pollution and mitigation costs of the Paris agreement: a modelling study. Lancet Planet Health 2018;2:e126–33. 2 Intergovernmental panel on climate change. summary for policymakers. in: global warming of 1.5°C. An IPCC special report on the impacts of 23 Paremoer L, Nandi S, Serag H, et al. Covid-19 pandemic and the social determinants of health. BMJ 2021;372:n129. global warming of 1.5°C above pre-industrial levels and r elated global Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Family Medicine and Community Health British Medical Journal

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

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British Medical Journal
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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
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2305-6983
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2009-8774
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Open access Editorial Call for emergency action to limit global temperature increases, restore biodiversity and protect health 1 2 3 4 Lukoye Atwoli, Abdullah H Baqui, Thomas Benfield, Raffaella Bosurgi, 5 6 7 8 Fiona Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn- Langton, 9 10 11 12 Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, 13 14 15 8 Marcel GM Olde Rikkert, Eric J Rubin, Peush Sahni, Richard Smith, 16 17 18 Nicholas J Talley, Sue Turale, Damián Vázquez Wealthy nations must do much more, increased dehydration and renal function much faster. loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and To cite: Atwoli L, H Baqui A, The United Nations General Assembly cardiovascular and pulmonary morbidity Benfield T, et al. Call for 5 6 in September 2021 will bring countries and mortality. Harms disproportionately emergency action to limit together at a critical time for marshalling affect the most vulnerable, including chil- global temperature increases, collective action to tackle the global envi- restore biodiversity and protect dren, older populations, ethnic minorities, health. Fam Med Com Health ronmental crisis. They will meet again at poorer communities and those with under- 2021;9:e001369. doi:10.1136/ 2 4 the biodiversity summit in Kunming, China, lying health problems. fmch-2021-001369 and the climate conference (Conference Global heating is also contributing to the of the Parties (COP)26) in Glasgow, UK. Received 13 August 2021 decline in global yield potential for major Ahead of these pivotal meetings, we—the Accepted 16 August 2021 crops, falling by 1.8%–5.6% since 1981; editors of health journals worldwide—call this, together with the effects of extreme for urgent action to keep average global weather and soil depletion, is hampering temperature increases below 1.5°C, halt the efforts to reduce undernutrition. Thriving destruction of nature and protect health. ecosystems are essential to human health, Health is already being harmed by global and the widespread destruction of nature, temperature increases and the destruction including habitats and species, is eroding of the natural world, a state of affairs health water and food security and increasing the professionals have been bringing attention 3 7 8 chance of pandemics. to for decades. The science is unequivocal; The consequences of the environmental a global increase of 1.5°C above the prein- crisis fall disproportionately on those coun- dustrial average and the continued loss of tries and communities that have contrib- biodiversity risk catastrophic harm to health 2 3 uted least to the problem and are least that will be impossible to reverse. Despite able to mitigate the harms. Yet no country, the world’s necessary preoccupation with no matter how wealthy, can shield itself COVID-19, we cannot wait for the pandemic from these impacts. Allowing the conse- to pass to rapidly reduce emissions. © Author(s) (or their quences to fall disproportionately on the Reflecting the severity of the moment, employer(s)) 2021. Re- use most vulnerable will breed more conflict, permitted under CC BY. this editorial appears in health journals Published by BMJ. food insecurity, forced displacement and across the world. We are united in recog- For numbered affiliations see zoonotic disease, with severe implications nising that only fundamental and equitable end of article. for all countries and communities. As with changes to societies will reverse our current the COVID-19 pandemic, we are globally as trajectory. Correspondence to strong as our weakest member. The risks to health of increases above Mr Laurie Laybourn- Langton, UK Health Alliance on Climate Rises above 1.5°C increase the chance 1.5°C are now well established. Indeed, Change, C/O BMJ Publishing no temperature rise is ‘safe’. In the past 20 of reaching tipping points in natural Group, Tavistock Square, London systems that could lock the world into an years, heat- related mortality among people WC1H 9JR, UK; acutely unstable state. This would criti- aged over 65 has increased by more than laurie. laybourn@ ukhealthalliance. org 50%. Higher temperatures have brought cally impair our ability to mitigate harms Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 1 Open access and to prevent catastrophic, runaway environmental that the rush for cleaner technologies does not come 9 10 change. at the cost of more environmental destruction and human exploitation. Many governments met the threat of the COVID-19 GLOBAL TARGETS ARE NOT ENOUGH pandemic with unprecedented funding. The environ- Encouragingly, many governments, financial institu- mental crisis demands a similar emergency response. tions and businesses are setting targets to reach net- Huge investment will be needed, beyond what is being zero emissions, including targets for 2030. The cost of considered or delivered anywhere in the world. But renewable energy is dropping rapidly. Many countries such investments will produce huge positive health are aiming to protect at least 30% of the world’s land and economic outcomes. These include high- quality and oceans by 2030. jobs, reduced air pollution, increased physical activity, These promises are not enough. Targets are easy to and improved housing and diet. Better air quality set and hard to achieve. They are yet to be matched alone would realise health benefits that easily offset with credible short- term and longer- term plans to accel- the global costs of emissions reductions. erate cleaner technologies and transform societies. These measures will also improve the social and Emissions reduction plans do not adequately incorpo- economic determinants of health, the poor state of rate health considerations. Concern is growing that which may have made populations more vulnerable temperature rises above 1.5°C are beginning to be seen to the COVID-19 pandemic. But the changes cannot as inevitable, or even acceptable, to power ful members be achieved through a return to damaging austerity of the global community. Relatedly, current strategies policies or the continuation of the large inequalities of for reducing emissions to net zero by the middle of the wealth and power within and between countries. century implausibly assume that the world will acquire great capabilities to remove greenhouse gases from the 14 15 atmosphere. COOPERATION HINGES ON WEALTHY NATIONS DOING MORE This insufficient action means that temperature In particular, countries that have disproportionately increases are likely to be well in excess of 2°C, a cata- created the environmental crisis must do more to strophic outcome for health and environmental stability. support low- income and middle- income countries to Critically, the destruction of nature does not have parity build cleaner, healthier and more resilient societies. of esteem with the climate element of the crisis, and every High- income countries must meet and go beyond their single global target to restore biodiversity loss by 2020 was outstanding commitment to provide $100 billion a 17 18 missed. This is an overall environmental crisis. year, making up for any shortfall in 2020 and increasing Health professionals are united with environmental contributions to and beyond 2025. Funding must scientists, businesses and many others in rejecting that be equally split between mitigation and adaptation, this outcome is inevitable. More can and must be done including improving the resilience of health systems. now—in Glasgow and Kunming—and in the imme- Financing should be through grants rather than diate years that follow. We join health professionals loans, building local capabilities and truly empowering worldwide who have already supported calls for rapid communities, and should come alongside forgiving 1 19 action. large debts, which constrain the agency of so many Equity must be at the centre of the global response. low- income countries. Additional funding must be Contributing a fair share to the global effort means marshalled to compensate for inevitable loss and that reduction commitments must account for the damage caused by the consequences of the environ- cumulative, historical contribution each country has mental crisis. made to emissions, as well as its current emissions and As health professionals, we must do all we can to capacity to respond. Wealthier countries will have to aid the transition to a sustainable, fairer, resilient and cut emissions more quickly, making reductions by 2030 healthier world. Alongside acting to reduce the harm 20 21 beyond those currently proposed and reaching net- from the environmental crisis, we should proactively zero emissions before 2050. Similar targets and emer- contribute to global prevention of further damage and gency action are needed for biodiversity loss and the action on the root causes of the crisis. We must hold wider destruction of the natural world. global leaders to account and continue to educate To achieve these targets, governments must make others about the health risks of the crisis. We must join fundamental changes to how our societies and econ- in the work to achieve environmentally sustainable omies are organised and how we live. The current health systems before 2040, recognising that this will strategy of encouraging markets to swap dirty for mean changing clinical practice. Health institutions cleaner technologies is not enough. Governments have already divested more than $42 billion of assets must intervene to support the redesign of transport from fossil fuels; others should join them. systems, cities, production and distribution of food, The greatest threat to global public health is the markets for financial investments, health systems, and continued failure of world leaders to keep the global much more. Global coordination is needed to ensure temperature rise below 1.5°C and to restore nature. 2 Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 Open access greenhouse gas emission pathways, in the context of strengthening Urgent, society- wide changes must be made and will the global response to the threat of climate change, sustainable lead to a fairer and healthier world. We, as editors of development, and efforts to eradicate poverty, 2018. Available: https:// health journals, call for governments and other leaders www. ipcc. ch/ sr15/ 3 Intergovernmental Science-Policy platform on biodiversity and to act, marking 2021 as the year that the world finally ecosystem services. summary for policymakers: the global changes course. assessment report on biodiversity and ecosystem services, 2019. Available: https:// ipbes. net/ sites/ default/ files/ 2020- 02/ ipbes_ global_ assessment_ report_ summary_ for_ policymakers_ en. pdf Author affiliations 4 Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet East African Medical Journal, Nairobi, Kenya countdown on health and climate change: responding to converging Journal of Health, Population and Nutrition, Baltimore, Maryland, USA crises. Lancet 2021;397:129–70. Danish Medical Journal, Copenhagen, Denmark 5 Rocque RJ, Beaudoin C, Ndjaboue R, et al. Health effects of PLOS Medicine, Cambridge, UK climate change: an overview of systematic reviews. BMJ Open 2021;11:e046333. The BMJ, London, UK 6 6 Haines A, Ebi K. The imperative for climate action to protect British Dental Journal, London, UK health. N Engl J Med 2019;380:263–73. The Lancet, London, UK 7 United Nations Environment Programme and International Livestock UK Health Alliance on Climate Change, London, UK Research Institute. Preventing the next pandemic: zoonotic diseases Revista de Saúde Pública, São Paulo, Brazil and how to break the chain of transmission, 2020. Available: https:// International Journal of Nursing Studies, London, UK72d37324- 5089- 459c- 8f70- 271d19427cf2. filesusr. com/ ugd/ 056cf4_ b5b2 fc06 7f09 4dd3 b225 0cda 15c47acd. pdf CMAJ, Ottawa, Ontario, Canada 12 8 IPCC. Summary for policymakers. In: Climate change and land: Pharmaceutical Journal, London, UK an IPCC special report on climate change, desertification, land Dutch Journal of Medicine, Nijmegen, The Netherlands degradation, sustainable land management, food security, and NEJM, Boston, Massachusetts, USA greenhouse gas fluxes in terrestrial ecosystems, 2019. National Medical Journal of India, New Delhi, India 9 Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points— Medical Journal of Australia, Newcastle, New South Wales, Australia too risky to bet against. Nature 2019;575:592–5. 10 Wunderling N, Donges JF, Kurths J, et al. Interacting tipping elements International Nursing Review, Geneva, Switzerland 18 increase risk of climate domino effects under global warming. Earth Pan American Journal of Public Health, Washington, DC, USA Syst Dynam 2021;12:601–19. 11 High ambition coalition. Available: https://www. hacf orna ture andp Funding The authors have not declared a specific grant for this research from any eople. org funding agency in the public, commercial or not- for- profit sectors. 12 Global Climate and Health Alliance. Are national climate commitments enough to protect our health? Available: https:// clim Editor's note This editorial is being published simultaneously in many international atea ndhe alth alliance. org/ initiatives/ healthy- ndcs/ ndc- scorecards/ journals. Please see the full list here: https://www. bmj. com/ content/full- list- 13 Climate strikers: Open letter to EU leaders on why their new climate authors- and- signatories- climate- emergency- editorial- september- 2021 law is ‘surrender.’ Carbon Brief, 2020. Available: https://www. carbonbrief. org/ climate- strikers- open- letter- to- eu- leaders- on- why- Competing interests FG serves on the executive committee for the UK Health their- new- climate- law- is- surrender Alliance on Climate Change and is a trustee of the Eden Project. RS is the chair of 14 Fajardy M, Köberle A, MacDowell N, et al. “BECCS deployment: a Patients Know Best, has stock in UnitedHealth Group, has done consultancy work reality check.” Grantham Institute briefing paper 28, 2019. Available: for Oxford Pharmagenesis and is chair of the Lancet Commission on the Value of https://www. imperial. ac. uk/ media/ imperial- college/ grantham- Death. institute/ public/ publications/ briefing- papers/ BECCS- deployment- a- reality- check. pdf Patient and public involvement Patients and/or the public were not involved in 15 Anderson K, Peters G. The trouble with negative emissions. Science the design, or conduct, or reporting, or dissemination plans of this research. 2016;354:182–3. 16 Climate action tracker. Available: https:// climateactiontracker. org Patient consent for publication Not required. 17 Secretariat of the convention on biological diversity. global Provenance and peer review Commissioned; internally peer reviewed. biodiversity outlook 5, 2020. Available: https://www.cbd. int/ gbo5 18 Steffen W, Richardson K, Rockström J, et al. Sustainability. planetary Open access This is an open access article distributed in accordance with the boundaries: guiding human development on a changing planet. Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits Science 2015;347:1259855. others to copy, redistribute, remix, transform and build upon this work for any 19 UK Health Alliance. Our calls for action. Available: http://www. purpose, provided the original work is properly cited, a link to the licence is given, ukhealthalliance. org/ cop26/ and indication of whether changes were made. See: https:// creativecommons. org/ 20 Climate Action Tracker. Warming projections global update: may licenses/ by/ 4. 0/.2021. Available: https:// climateactiontracker. org/ documents/ 853/ CAT_ 2021- 05- 04_ Briefing_ Global- Update_ Climate- Summit- Momentum. pdf 21 United Nations Environment Programme. Emissions gap report 2020. UNEP, 2020. 22 Markandya A, Sampedro J, Smith SJ, et al. Health co- benefits from REFERENCES 1 In support of a health recovery. Available: https://healthyr ecovery.net air pollution and mitigation costs of the Paris agreement: a modelling study. Lancet Planet Health 2018;2:e126–33. 2 Intergovernmental panel on climate change. summary for policymakers. in: global warming of 1.5°C. An IPCC special report on the impacts of 23 Paremoer L, Nandi S, Serag H, et al. Covid-19 pandemic and the social determinants of health. BMJ 2021;372:n129. global warming of 1.5°C above pre-industrial levels and r elated global Atwoli L, et al. Fam Med Com Health 2021;9:e001369. doi:10.1136/fmch-2021-001369 3

Journal

Family Medicine and Community Health – British Medical Journal

Published: Sep 5, 2021

Keywords: health services researchoutcome and process assessmentoutcome assessmenthealth care

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