“The greatest threat to global public health”

by | October 8, 2021

In an unprecedented move, 233 of health journals around the world simultaneously published a joint article last month calling continued inaction on climate “the greatest threat to global public health”.

I shared a link to this a few weeks ago. But I found it extremely powerful so I wanted to share the full thing with you in case you haven’t seen it (they gave me the green light to republish it).

Doctors, nurses, and healthcare professionals all over the world are yelling from the rooftops, demanding climate action for the health of people everywhere.

I want to do what little I can to help amplify their voices and their message.

And I encourage you to do the same.

Lastly, a massive thank you to the 250+ health journals who published or supported this piece. (Please keep speaking up on climate – we need your voices!)

I wanted you to see for yourself both the number and diversity of these journals so I’ve included the full list below. The unity across so many subjects and geographies is quite impressive.

Okay, that’s enough from me. Enjoy these clear, passionate, and powerful words from our health experts:

Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health

The United Nations 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 at the climate conference (COP26) in Glasgow, United Kingdom. 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 recognizing 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 over 65 years of age 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, which has fallen by 1.8 to 5.6% since 1981; this decline, 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 center 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 proposed20,21 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 organized 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 realize 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 $100 billion 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 to 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, recognizing that this will mean changing clinical practice. Health institutions have already divested more than $42 billion 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.

This editorial was published on September 5, 2021, at

From: New England Journal of Medicine, Lukoye Atwoli, Abdullah H. Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, et al., Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health, 385:1134-1137, © (2021) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

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

This editorial was published simultaneously in the following journals:

  • Acta Orthopaedica et Traumatologica Turcica
  • Advances in Nursing Science
  • Advances in Nutrition
  • African Journal of Laboratory Medicine
  • Afro-Egyptian Journal of Infectious and Endemic Diseases
  • Age and Ageing
  • Alcohol and Alcoholism
  • Allergy
  • Alpha Psychiatry
  • American Journal of Clinical Pathology
  • American Journal of Health-System Pharmacy
  • American Journal of Hypertension
  • American Society of Microbiology
  • Animal Bioscience
  • Annals of African Surgery
  • Annals of Behavioral Medicine
  • Annals of Oncology
  • Annals of Global Health
  • Annals of the Rheumatic Diseases
  • Annals of the Royal College of Surgeons of England
  • Archives of Disease in Childhood
  • Archives of the Turkish Society of Cardiology
  • Asia Pacific Journal of Public Health
  • Balkan Medical Journal
  • Belgian Journal of Medicine
  • Biosis: Biological Systems
  • BJOG
  • BMJ Case Reports
  • BMJ Evidence-Based Medicine
  • BMJ Global Health
  • BMJ Health & Care Informatics
  • BMJ Innovations
  • BMJ Leader
  • BMJ Military Health
  • BMJ Nutrition, Prevention & Health
  • BMJ Open
  • BMJ Open Gastroenterology
  • BMJ Open Ophthalmology
  • BMJ Open Quality
  • BMJ Open Respiratory Research
  • BMJ Open Science
  • BMJ Open Sport & Exercise Medicine
  • BMJ Paediatrics Open
  • BMJ Quality & Safety
  • BMJ Sexual & Reproductive Health
  • BMJ Supportive & Palliative Care
  • BMJ Surgery, Interventions, & Health Technologies
  • Bosnian Journal of Basic Medical Sciences
  • Brain
  • Brain Communications
  • British Dental Journal
  • British Journal of Clinical Pharmacology
  • British Journal of General Practice
  • British Journal of Ophthalmology
  • British Journal of Sports Medicine
  • British Medical Bulletin
  • Bulletin of the World Health Organization
  • Cadernos de Saúde Pública
  • Canadian Journal of Respiratory Therapy
  • Canadian Medical Association Journal
  • Cardiovascular Research
  • Caribbean Medical Journal
  • Chinese Science Bulletin
  • CIN: Computers, Informatics, Nursing
  • Clinical Medicine
  • Croatian Medical Journal
  • Crohn’s & Colitis 360
  • Cureus Journal of Medical Science
  • Current Developments in Nutrition
  • Danish Medical Journal
  • Diseases of the Colon & Rectum
  • Dutch Journal of Medicine
  • East African Medical Journal
  • EBioMedicine
  • EClinicalMedicine
  • Emergency Medicine Journal
  • EP Europace
  • European Heart Journal
  • European Heart Journal – Acute Cardiovascular Care
  • European Heart Journal – Cardiovascular Imaging
  • European Heart Journal – Case Reports
  • European Heart Journal – Digital Health
  • European Heart Journal – Quality of Care and Clinical Outcomes
  • European Heart Journal – Cardiovascular Pharmacotherapy
  • European Journal of Cardio-Thoracic Surgery
  • European Journal of Cardiovascular Nursing
  • European Journal of Hospital Pharmacy
  • European Journal of Preventive Cardiology
  • European Journal of Public Health
  • Evidence-Based Mental Health
  • Evidence-Based Nursing
  • Family Medicine and Community Health
  • Family Practice
  • Finnish Medical Journal
  • Frontline Gastroenterology
  • Gaceta Sanitaria
  • Gastrointestinal Nursing
  • General Psychiatry
  • Global Health Action
  • Global Heart
  • Global Journal of Medicine and Public Health
  • Health Policy and Planning
  • Health Promotion International
  • Health Promotion Journal of Australia
  • Heart
  • Huisarts en wetenschap
  • Human Molecular Genetics
  • Human Reproduction
  • IJQHC Communications
  • Indian Journal of Medical Ethics
  • Indian Journal of Medical Research
  • Inflammatory Bowel Diseases
  • Injury Prevention
  • Innovation in Aging
  • Integrated Healthcare Journal
  • International Journal of Epidemiology
  • International Journal of Gynaecology & Obstetrics
  • International Journal of Gynecological Cancer
  • International Journal of Health Policy and Management
  • International Journal of Integrated Care
  • International Journal of Medical Students
  • International Journal of Nursing Studies
  • International Journal of Older People Nursing
  • International Journal of Pharmacy Practice
  • International Nursing Review
  • ISA (ingeniería Sanitaria y Ambiental)
  • JAMIA Open
  • JMIR Public Health & Surveillance
  • JNCI Cancer Spectrum
  • Journal of Child Health Care
  • Journal of Clinical Pathology
  • Journal of Crohn’s and Colitis
  • Journal of Epidemiology & Community Health
  • Journal of Health and Caring Sciences
  • Journal of Health, Population and Nutrition
  • Journal of Medical Ethics
  • Journal of Medical Genetics
  • Journal of Medical Imaging and Radiation Sciences
  • Journal of Nepal Paediatric Society
  • Journal of Neurology Neurosurgery & Psychiatry
  • Journal of Open Health Data
  • Journal of Pharmacuetical Health Services Research
  • Journal of Pharmacy and Pharmacology
  • Journal of Public Health
  • Journal of Surgical Case Reports
  • Journal of Surgical Protocols and Research Methodologies
  • Journal of the American Medical Informatics Association
  • Journal of the Medical Association of Thailand
  • Journal of the National Cancer Institute
  • Journal of the Norwegian Medical Association
  • Journal of the Royal Society of Medicine
  • Journal of Travel Medicine
  • Journal of Tropical Pediatrics
  • Journal of Turkish Society of Microbiology
  • Kafkas Universitesi Veteriner Fakültesi Dergisi
  • Khyber Medical University Journal
  • Lab Medicine
  • Medical Humanities
  • Medical Journal of Australia
  • Medical Mycology
  • Medwave
  • Nephrology Dialysis Transplantation
  • Neuro-Oncology Advances
  • Neuro-Oncology Practice
  • Neurology
  • New England Journal of Medicine
  • Nicotine & Tobacco Research
  • Nurse Author & Editor
  • Nursing Inquiry
  • Nutrition Reviews
  • Occupational and Environmental Medicine
  • Occupational Medicine
  • Oxford Open Climate Change
  • Oxford Open Immunology
  • Pacific Rim Journal of International Nursing Research
  • Paediatrics & Child Health
  • Palliative Medicine
  • Pan American Journal of Public Health
  • Pediatric Infectious Disease Society of the Philippines Journal
  • Pediatric Nursing
  • The Pharmaceutical Journal
  • PLOS Medicine
  • Postgraduate Medical Journal
  • Psychiatry and Clinical Psychopharmacology
  • PTJ: Physical Therapy & Rehabilitation Journal
  • Revista de la Facultad de Medicina Humana
  • Revista de Saúde Pública
  • Rheumatology
  • RMD Open
  • Schizophrenia Bulletin
  • Schizophrenia Bulletin Open
  • Sexually Transmitted Infections
  • SLEEP Advances
  • Stroke and Vascular Neurology
  • The American Journal of Clinical Nutrition
  • The BMJ
  • The Gerontologist
  • The Journal of Climate Change and Health
  • The Journal of Nutrition
  • The Journals of Gerontology, Series A
  • The Lancet
  • The Lancet Child & Adolescent Health
  • The Lancet Global Health
  • The Lancet Infectious Diseases
  • The Lancet Microbe
  • The Lancet Planetary Health
  • The Lancet Psychiatry
  • The Lancet Public Health
  • The Lancet Regional Health – Americas
  • The Lancet Regional Health – Europe
  • The Lancet Regional Health – Western Pacific
  • The National Medical Journal of India
  • The Pan-American Journal of Ophthalmology
  • Thorax
  • Tobacco Control
  • Translational Behavioral Medicine
  • Tropical Journal of Pharmaceutical Research
  • Turkish Archives of Otorhinolaryngology
  • Turkish Archives of Pediatrics
  • Turkish Journal of Anaesthesiology and Reanimation
  • Turkish Journal of Biochemistry
  • Turkish Journal of Cardiovascular Nursing
  • Turkish Journal of Orthodontics
  • Turkish Thoracic Journal
  • Universitas Medica
  • Veterinary Record
  • Western Journal of Emergency Medicine
  • Women’s Healthcare: A Clinical Journal for NPs
  • World Journal of Pediatric Surgery

In addition, the following journals are supporting the editorial

  • American Family Physician
  • International Journal of Cancer
  • Journal of Manipulative and Physiological Therapeutics
  • Pakistan Journal of Medical Sciences
  • Philippine Journal of Otolaryngology Head and Neck Surgery
  • The Lancet Digital Health
  • The Lancet Gastroenterology & Hepatology
  • The Lancet Haematology
  • The Lancet Healthy Longevity
  • The Lancet HIV
  • The Lancet Respiratory Medicine
  • The Lancet Rheumatology
  • Open Journal of Bioresources
  • Veterinary Anaesthesia and Analgesia
  • Journal of Advanced Nursing
  • Journal of Clinical Nursing
  • Nursing Open
  • Revista Venezolana de Salud Pública
  • Revista Médica del Uruguay
  • Revista Argentina de Salud Pública
  • GeoHealth
  • American Geophysical Union Journals
  • Methodist DeBakey Cardiovascular Journal

That’s a whole lotta healthcare professionals demanding immediate and bold climate action for human health.

Perhaps the leaders of countries, states, cities, communities, corporations, schools, institutions, etc. should listen to them.

Or, more realistically, perhaps we all need to do whatever we can to make sure the leaders in our spheres of influence make climate positive policy and investment decisions from here on out.

This post originally featured in the Crowdsourcing Sustainability newsletter. Sign up for the newsletter below!

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