As an island nation with a temperate climate and regular rainfall, Britain has
never much wanted for water. Our summers are occasionally hot, mostly mild
and invariably thought to be disappointing. The South of England may get hit
with the odd hosepipe ban, but the popular pastimes of excessive car washing
and patio cleaning are never lost for long.
That we do not suffer from severe “water stress”, when demand outstrips
supply, is a reason the urgency of global warming goes relatively unnoticed.
With water stress come crises in public health, including disease, poor
sanitation and malnutrition, and climate change takes on a very human
dimension.
Britain will not lack this human dimension for long. Of all the climatic
shifts, water-related problems are arguably the most imminent and most
personal; as the country’s temperature rises and weather patterns become
more extreme, health will be compromised by a lack of clean water and
diseases spread by polluted floodwater. Health professionals — until now
noticeable only by their absence in the climate change debate — will become
increasingly important in helping us to understand and adapt to problems and
in promoting behavioural changes that might avert the greatest threats.
Three publications have made the link between public health and global warming
in Britain in recent weeks. The Department of Health heatwave plan made no
explicit reference to climate change but underlined the risk of dehydration
and respiratory problems during increasingly hot summers. The Marine
Conservation Society slashed the number of beaches meeting quality standards
after heavy rainfall increased pollution in rivers and seas, and called for
a reassessment of storm pollution measures in the face of more unstable
weather patterns. And an academic commission from University College London,
reporting in The Lancet, warned that climate change posed the biggest
global health threat of the 21st century. The scientists said that a lack of
clean water and the spread of diseases exacerbated by more frequent flooding
were among the most obvious health implications for Britain.
The significance of the latter report was not only its content — setting out
the direct and indirect effects of global warming, from changing patterns of
infection to large-scale migration — but also its authors. The lead
researchers, and most prominent advocates for action, were those rarest of
voices: doctors.
They observed that even the most modest of predicted temperature rises will
exert extraordinary pressures on health, and not just in those
well-documented areas prone to severe drought and flooding. Professor Hugh
Montgomery, of UCL, says that in Britain the NHS will need to cater for
increasing numbers of heat-related admissions — as shown by the estimated
70,000 excess deaths attributed to the Northern European heatwave of 2003.
Changing patterns of disease and mortality would emerge in a greater rate of
transmission and spread of traditionally tropical endemic diseases, such as
dengue fever, West Nile fever and even the re-establishment of malaria in
the UK. While health impacts are likely to be localised, more cases could be
imported among travellers returning to this country. Either way, most
industrialised nations’ health systems are ill-prepared for tropical disease
treatment, which at present tends to be relegated to speciality medical
facilities.
Communities affected by flooding face the threats of a range of bacteria and
viruses, including food poisoning from salmonella and E. coli (also a
risk from higher summer temperatures), and raised levels of campylobacter
and cryptosporidium infections. Cases of gastroenteritis — causing severe
stomach upsets, diarrhoea and vomiting — will also rise rapidly if drinking
water supplies are compromised.
However, the most striking point made by the doctors was a confession that
their profession had been shamefully silent on the health threats of climate
change. Medics should be articulating the message more often, and more
loudly.
The drive for a new era of public health advocacy linked to climate change was
reiterated in even stronger terms at a private dinner in Central London last
month. The event — attended by diplomats and politicians, students,
clinicians and research scientists — was as rare as its participants were
varied and focused, amid hand-wringing confessions of professional inertia,
on the need for a medical call-to-arms. There were even calls from several
of the 18 seats around the table for nonviolent direct action. None came
from the students.
This message went public in The Times this week , in an article written
by Professor Sir Muir Gray, the screening pioneer and chief knowledge
officer of the NHS. He argued that doctors must accept that ignoring climate
change is a neglect of duty and should be campaigning on the subject in the
same way that Victorian medics did on cholera. In an age of tainted
politics, failure to engage is an opportunity wasted from a profession in a
position of public trust. His hope, like that of Professor Anthony Costello,
of the Institute of Global Health at UCL and lead author of The Lancet
paper, is that a tipping point is reached shortly that ensures that the
health lobby enters the climate change mitigation debate.
Such issues will be considered in the Sustainable World series of debates at The
Times Cheltenham Science Festival next week. Gareth Pender, Professor of
Environmental Engineering at Heriot-Watt University, who will speak on
“Flood Defence”, argues that the Government should gauge flooding risks not
only in terms of cost to infrastructure, but also impact on human health.
While the consequences of flooding are calculated in the financial terms of
building damage and population displacement, the burden of disease and
mental health are rarely considered, he says.
Britain’s network of “combination sewers” means that stormwater can enter
sewerage pipes, bringing pathogens to the surface as the system overflows,
as seen during the Gloucestershire floods of 2007.
“We can predict where floodwater will go, the likely volumes, the
contamination risk, how diluted the pollutants will be and the probable
numbers that will fall ill. These are vital in terms of assessing the full
impact of such events.”
For Bruce Horton, environmental adviser to Water UK and another speaker at
Cheltenham, the growing demands made of the country’s water system are
unsustainable. “The average person’s daily water usage has increased by 50
per cent in a generation, to 150 litres,” Horton says. “Water’s carbon
footprint is very large, with treatment and pumping accounting for five
million tonnes of carbon a year on their own. This has to be reduced.”
In 2002 8 per cent of the world suffered water shortages, but by 2050 this
figure could jump to 40 per cent. As one expert put it, as dry areas become
drier and wet areas become wetter, clean water could become more important
than oil within the next few decades. Changing rainfall and temperature will
make the provision of clean water, good sanitation and drainage even more
complicated than it is now. No society will be exempt from the great water
debate.
The role of the doctor as advocate of healthy, abstemious, low-carbon living,
and harbinger of public health perils that await if climate change is
neglected, is, therefore, all the more important. For those reticent about
speaking out — arguing the uncertainty of the exact health impacts — the
“precautionary principle”, as defined by the renowned epidemiologist Sir
Austin Bradford-Hill, should be considered. Scientific uncertainty is
pervasive — all research is incomplete, “whether observational or
experimental, and liable to be upset or modified by advancing knowledge”,
Sir Austin observed. “This does not confer upon us a freedom to ignore the
knowledge we already have or postpone the action that it appears to demand
at a given time.”
The threats are there, the action demanded and the timing critical. It may be
that the duty of the public health professional is discussed in another of
the Cheltenham sessions, Climate Change: Whose Responsibility? (June 5,
12.30 pm), and the possible contributions covered in the debate on revival
of environmental awareness, The Green Resurgent: Tactics, Politics and
Science (June 5, 2 pm). One can argue that the doctor’s role, armed with
public health evidence as exemplified by water problems, can make the public
message most persuasive, building a solidarity and authority that Britain’s
leaders will find hard to resist.
One step at a time — but next year we may even find that the festival’s
environmentalists, ecologists and politicians are joined by doctors for the
debate.
